Toux chronique de l’adulte et reflux gastro-œsophagien

E. Cauchin , J.-P. Galmiche
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Abstract

Respiratory manifestations represent one of the most prevalent and difficult to manage extra-esophageal syndromes of GORD. However, the relationship between reflux and respiratory symptoms such as chronic cough is frequently difficult to establish with a high degree of certainty. The causality of reflux in cough can be supported by several different pieces of evidence, including (1) a significant epidemiological association between GORD and respiratory symptoms, (2) a temporal relationship between cough occurrence and reflux episodes (as shown by pH or pH-impedance monitoring). The diagnosis of GORD is easily made if the patient complains of typical symptoms, such as heartburn and regurgitation, or if endoscopy shows unequivocal signs of esophagitis (i.e. mucosal breaks). However, in the case of GORD-related cough, the typical digestive syndrome is frequently absent, a situation corresponding to the so-called “silent GORD”. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and Proton Pump Inhibitors (PPI) in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring.

成人慢性咳嗽及胃食管反流
呼吸表现是GORD最常见和最难处理的食管外综合征之一。然而,反流与呼吸道症状(如慢性咳嗽)之间的关系往往难以高度确定。咳嗽反流的因果关系可以得到几个不同证据的支持,包括:(1)GORD与呼吸道症状之间存在显著的流行病学关联;(2)咳嗽发生与反流发作之间存在时间关系(如pH值或pH阻抗监测所示)。如果患者主诉有典型症状,如胃灼热和反流,或内镜检查显示明确的食管炎征象(如粘膜破裂),则很容易诊断GORD。然而,在与GORD相关的咳嗽中,通常没有典型的消化综合征,这种情况对应于所谓的“沉默的GORD”。反流可通过微吸、局部和中枢反射等不同机制诱发慢性咳嗽。咳嗽和反流可能相互沉淀。一项荟萃分析发现,安慰剂和质子泵抑制剂(PPI)在缓解咳嗽方面没有显著差异。根据ph阻抗监测选择的患者进行抗反流手术后,已报道了令人鼓舞的结果。未来的试验应集中于患者选择和使用最新开发的技术(如ph阻抗监测)控制疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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