哮喘联盟

   摘要
   背景：胃食管反流性疾病(GERD)和慢性咳嗽之间的相关性尚未确证。
   目的：比较GERD儿童、胃食管反流 (GER) 相关咳嗽(GrC)儿童和正常儿童的食管粘膜细胞间隙直径(ISD)，探讨GER相关咳嗽儿童基线阻抗水平和ISD扩张间的关系。
   方法：40例GERD儿童、15例GrC儿童和12例正常儿童胃镜(EGD)下在鳞柱状上皮交界上2-3cm处取活检。采用透射电镜检测ISD。在两组患者中均监测末梢阻抗通道的阻抗-pH，并检测基线阻抗。
   结果：GrC患者(0.9 ± 0.2 μm) 和正常组(0.5 ± 0.2 μm, P < 0.001)相比平均ISD存在显著差异，但是GrC 组和GERD组(1 ± 0.3 μm, NS)相比无显著差异。GrC儿童在有或无病理性食管酸暴露时，平均ISD无差异(1 ± 0.3 vs. 0.9 ± 0.2 μm)，且ISD与任何反流指标不相关。最后，ISD与末梢基线阻抗值不相关(r:-0.35; NS)。
   结论：在反流相关咳嗽的儿童中，细胞间隙直径扩张似乎是食管黏膜损伤的一项客观、有效的检测指标，且与酸暴露无关，在诊断不明确的患者中应该考虑检测该指标。对于反流相关咳嗽儿童，基线阻抗水平对反流引起的食管粘膜超微结构的改变无鉴别意义。
 

（刘国梁 审校）
Aliment Pharmacol Ther. 2014 Apr;39(7):733-42. doi: 10.1111/apt.12652. Epub 2014 Feb 11.

 

Dilated intercellular space diameter as marker of reflux-related mucosal injury in children with chronic cough and gastro-oesophageal reflux disease.
 

Borrelli O1, Mancini V, Thapar N, Ribolsi M, Emerenziani S, De'angelis G, Bizzarri B, Lindley KJ, Cicala M.
 

Abstract
BACKGROUND: The diagnostic corroboration of the relationship between gastro-oesophageal reflux disease (GERD) and chronic cough remains challenging.
AIMS: To compare oesophageal mucosal intercellular space diameter (ISD) in children with GERD, children with gastro-oesophageal reflux (GER)-related cough (GrC) and a control group, and to explore the relationship between baseline impedance levels and dilated ISD in children with GER-related cough.
METHODS: Forty children with GERD, 15 children with GrC and 12 controls prospectively underwent oesophagogastroduodenoscopy (EGD) with oesophageal biopsies taken 2-3 cm above squamocolumnar junction. ISD were quantified using transmission electron microscopy. Impedance-pH monitoring with evaluation of baseline impedance in the most distal impedance channel was performed in both patient groups.
RESULTS: A significant difference in mean ISD values was found between GrC patients (0.9 ± 0.2 μm) and controls (0.5 ± 0.2 μm, P < 0.001), whereas there was no difference between GrC and GERD group (1 ± 0.3 μm, NS). No difference was found in the mean ISD between GrC children with or without pathological oesophageal acid exposure time (1 ± 0.3 vs. 0.9 ± 0.2 μm), and there was no correlation between ISD and any reflux parameter. Finally, there was no correlation between ISD and distal baseline impedance values (r:-0.35; NS).
CONCLUSIONS: In children with reflux-related cough, dilated intercellular space diameter appears to be an objective and useful marker of oesophageal mucosal injury regardless of acid exposure, and its evaluation should be considered for those patients where the diagnosis is uncertain. In children with reflux-related cough, baseline impedance levels have no role in identifying reflux-induced oesophageal mucosal ultrastructural changes.
 

Aliment Pharmacol Ther. 2014 Apr;39(7):733-42. doi: 10.1111/apt.12652. Epub 2014 Feb 11.