反流性咳嗽新进展
2010/02/03
一般认为，胃食管反流病（GORD）和哮喘与鼻部疾病一起是导致慢性咳嗽的主要因素之一。抗酸治疗有效可对GORD进行诊断。然而GORD是一种较为复杂的疾病，可以表现为多种形式。近期有研究报道慢性咳嗽患者具有不同的GORD类型，及其致咳的潜在作用机制。可用多种方法对GORD进行评价，内镜检查能提供食管炎（如糜烂性疾病）证据；对无食管受损（如非糜烂性疾病）的患者中，24-h 非卧床食管pH值监测能显示食管内异常的酸性环境。随着食管阻抗监测的发展，通过近端延伸（如至食管上部咽喉），目前已能评价所有类型的反流事件（不管酸度如何）并能对反流进行分类。若反流与咳嗽存在显著的时间性关联，则慢性咳嗽患者考虑存在GORD。
近期研究评价了咳嗽和反流的相关性以及近端和远端/咽部反流和微量吸入在慢性咳嗽中的作用。越来越多的证据表明，较多患者都存在反流与咳嗽相关性，即使是食管内外无反流事件发生。
（刘国梁 审校）
Lung. 2009 Dec 19. [Epub ahead of print]
New Developments in Reflux-Associated Cough.
Smith J, Woodcock A, Houghton L.
Respiratory Research Group, The University of Manchester, Manchester, UK,
Gastro-oesophageal reflux disease (GORD) is generally considered one of the three main causes of chronic cough, along with asthma and nasal disease. The diagnosis of GORD is often based upon a successful trial of anti-acid treatment however GORD is a complex condition taking many forms. Only recently have studies started to address the different types of GORD in patients with chronic cough and how these may infer the mechanisms linking these common conditions. GORD can be assessed in a number of ways; whilst endoscopy provides evidence of oesophagitis (i.e. erosive disease), 24-h ambulatory oesophageal pH monitoring may demonstrate abnormal oesophageal acid exposure in the absence of oesophageal damage (i.e. non-erosive disease). The development of oesophageal impedance monitoring now allows the assessment of all reflux events (regardless of degree of acidity) and further classification of reflux by the proximal extension e.g. to upper oesophagus or even pharynx. Chronic cough patients may still be considered to have GORD if there is a significant temporal association between reflux events and coughing. Recent studies have examined the relationships between cough and reflux events, the roles of distal and proximal/pharyngeal reflux and also micro-aspiration in chronic cough patients. Increasing evidence suggests a significant proportion of patients display statistical associations between reflux and cough events, in the absence of an excessive numbers of reflux events either within or outside of the oesophagus.
Smith J, et al. Lung. 2009 Dec 19. [Epub ahead of print]
近期研究评价了咳嗽和反流的相关性以及近端和远端/咽部反流和微量吸入在慢性咳嗽中的作用。越来越多的证据表明，较多患者都存在反流与咳嗽相关性，即使是食管内外无反流事件发生。
（刘国梁 审校）
Lung. 2009 Dec 19. [Epub ahead of print]
New Developments in Reflux-Associated Cough.
Smith J, Woodcock A, Houghton L.
Respiratory Research Group, The University of Manchester, Manchester, UK,
Gastro-oesophageal reflux disease (GORD) is generally considered one of the three main causes of chronic cough, along with asthma and nasal disease. The diagnosis of GORD is often based upon a successful trial of anti-acid treatment however GORD is a complex condition taking many forms. Only recently have studies started to address the different types of GORD in patients with chronic cough and how these may infer the mechanisms linking these common conditions. GORD can be assessed in a number of ways; whilst endoscopy provides evidence of oesophagitis (i.e. erosive disease), 24-h ambulatory oesophageal pH monitoring may demonstrate abnormal oesophageal acid exposure in the absence of oesophageal damage (i.e. non-erosive disease). The development of oesophageal impedance monitoring now allows the assessment of all reflux events (regardless of degree of acidity) and further classification of reflux by the proximal extension e.g. to upper oesophagus or even pharynx. Chronic cough patients may still be considered to have GORD if there is a significant temporal association between reflux events and coughing. Recent studies have examined the relationships between cough and reflux events, the roles of distal and proximal/pharyngeal reflux and also micro-aspiration in chronic cough patients. Increasing evidence suggests a significant proportion of patients display statistical associations between reflux and cough events, in the absence of an excessive numbers of reflux events either within or outside of the oesophagus.
Smith J, et al. Lung. 2009 Dec 19. [Epub ahead of print]
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急性咳嗽：诊断和治疗挑战
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使哮喘患者的咳嗽反射中止
