儿童慢性咳嗽和胃食管反流：CHEST指南和专家小组报告
2019/06/13
摘要
背景：胃食管反流（GER）或胃食管反流疾病（GERD）是否会导致儿童慢性咳嗽是有争议的。用人群，干预，对比，结果（PICO）格式，我们进行了四次系统评价。对于慢性咳嗽（持续时间> 4周）且没有潜在肺部疾病的儿童：（1）没有胃肠道GER症状的患者，是否应该使用GERD的经验性治疗？ （2）有胃肠道GER症状，GERD治疗是否解决了咳嗽？ （3）有或没有胃肠道GER症状，应该使用基于GER的疗法吗？持续多长时间？ （4）如果怀疑GERD是病因，哪些调查和诊断标准最能确定GERD是导致咳嗽的原因？
方法：我们采用CHEST专家咳嗽小组的方案和美国胸科医师学会（CHEST）方法指南和GRADE（建议评估，发展和评估等级）框架。德尔菲方法用于获得共识。
结果：很少有随机对照试验解决了前两个问题，没有一个解决其他两个问题。单一荟萃分析（两项随机对照试验）显示各组之间无显著差异（GERD的任何干预与安慰剂对咳嗽消退相比; OR，1.14; 95％CI，0.45-2.93; P = 0.78）。质子泵抑制剂（与安慰剂相比）引起了更多严重的不良事件。现有CHEST咳嗽系统评价的定性数据与两项国际GERD指南一致。
结论：小组成员认为：（1）当没有GERD的临床特征时，不应使用GERD治疗; （2）应使用儿科GERD指南来指导治疗和调查。
Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report.
Chang AB, Oppenheimer JJ, Kahrilas PJ, Kantar A, Rubin BK, Weinberger M, Irwin RS; CHEST Expert Cough Panel.
Abstract
BACKGROUND:Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough?
METHODS:We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus.
RESULTS:Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P = .78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines.
CONCLUSIONS:The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.
背景：胃食管反流（GER）或胃食管反流疾病（GERD）是否会导致儿童慢性咳嗽是有争议的。用人群，干预，对比，结果（PICO）格式，我们进行了四次系统评价。对于慢性咳嗽（持续时间> 4周）且没有潜在肺部疾病的儿童：（1）没有胃肠道GER症状的患者，是否应该使用GERD的经验性治疗？ （2）有胃肠道GER症状，GERD治疗是否解决了咳嗽？ （3）有或没有胃肠道GER症状，应该使用基于GER的疗法吗？持续多长时间？ （4）如果怀疑GERD是病因，哪些调查和诊断标准最能确定GERD是导致咳嗽的原因？
方法：我们采用CHEST专家咳嗽小组的方案和美国胸科医师学会（CHEST）方法指南和GRADE（建议评估，发展和评估等级）框架。德尔菲方法用于获得共识。
结果：很少有随机对照试验解决了前两个问题，没有一个解决其他两个问题。单一荟萃分析（两项随机对照试验）显示各组之间无显著差异（GERD的任何干预与安慰剂对咳嗽消退相比; OR，1.14; 95％CI，0.45-2.93; P = 0.78）。质子泵抑制剂（与安慰剂相比）引起了更多严重的不良事件。现有CHEST咳嗽系统评价的定性数据与两项国际GERD指南一致。
结论：小组成员认为：（1）当没有GERD的临床特征时，不应使用GERD治疗; （2）应使用儿科GERD指南来指导治疗和调查。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Chest. 2019 Apr 16. pii: S0012-3692(19)30831-1. doi: 10.1016/j.chest.2019.03.035. [Epub ahead of print])
(Chest. 2019 Apr 16. pii: S0012-3692(19)30831-1. doi: 10.1016/j.chest.2019.03.035. [Epub ahead of print])
Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report.
Chang AB, Oppenheimer JJ, Kahrilas PJ, Kantar A, Rubin BK, Weinberger M, Irwin RS; CHEST Expert Cough Panel.
Abstract
BACKGROUND:Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough?
METHODS:We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus.
RESULTS:Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P = .78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines.
CONCLUSIONS:The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.
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