Abstract:
Gastroesophageal reflux disease (GERD) as a possible cause of chronic cough is known for decades. However, more than 75% of patients with extraoesophageal symptoms do not suffer from typical symptoms of GERD like pyrosis and regurgitations and have negative upper gastrointestinal endoscopy. For such a condition term laryngopharyngeal reflux (LPR) was introduced and is used for more than two decades. Since the comprehensive information on relationship between chronic cough and LPR is missing the aim of this paper is to summarize current knowledge based on review of published information during last 13 years. Laryngopharyngeal reflux is found in 20% of patients with chronic cough. The main and recognized diagnostic method for LPR is 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring, revealing reflux episodes irritating the upper and lower respiratory tract mucosa. The treatment of LPR should be initiated with dietary and lifestyle measures, followed by proton pump inhibitor (PPI) therapy and other measures. Despite progress, more research is needed for accurate diagnosis and targeted therapies. Key areas for exploration include biomarkers for diagnosis, the impact of non-acid reflux on symptom development, and the efficacy of new drugs. Further studies with a focused population, excluding other causes like asthma, and using new diagnostic criteria for LPR are essential. It\'s crucial to consider LPR as a potential cause of unexplained chronic cough and to approach diagnosis and treatment with a multidisciplinary perspective.
摘要:
胃食管反流病(GERD)作为慢性咳嗽的可能原因已有数十年的历史。然而,超过75%的有食管外症状的患者没有典型的GERD症状,如发热和反流,上消化道内镜检查阴性.对于这种情况,引入了咽喉反流(LPR),并使用了二十多年。由于缺乏有关慢性咳嗽与LPR之间关系的综合信息,因此本文的目的是根据对过去13年中已发表的信息的回顾来总结当前的知识。在20%的慢性咳嗽患者中发现咽喉反流。LPR的主要和公认的诊断方法是24小时多通道管腔内阻抗-pH(MII-pH)监测,显示反流发作刺激上、下呼吸道粘膜。LPR的治疗应通过饮食和生活方式措施开始,其次是质子泵抑制剂(PPI)治疗和其他措施。尽管取得了进展,需要更多的研究来进行准确的诊断和靶向治疗.探索的关键领域包括用于诊断的生物标志物,非酸反流对症状发展的影响,以及新药的功效。对重点人群的进一步研究,排除其他原因,如哮喘,使用新的LPR诊断标准至关重要。将LPR视为原因不明的慢性咳嗽的潜在原因,并以多学科的观点来进行诊断和治疗是至关重要的。