What Is Acid Reflux Cough?

Gastroesophageal reflux disease (GERD) is not only a disease of the stomach and esophagus, but its extradigestive performance, especially respiratory complications, is receiving increasing attention, such as chronic cough, chronic pharyngitis, bronchial asthma, aspiration pneumonia, etc. . Gastroesophageal reflux cough (GERC), about half of which are clinically manifested as chronic cough alone, without typical GERD reflux-like symptoms, are non-specific compared to chronic cough caused by other causes, and have certain diagnosis and treatment. Difficulty.

Reflux cough

Basic overview of reflux cough

Reflux cough symptoms

1. Cough: The cough can last from weeks to years.

2. Sputum: mainly dry cough, some patients can sputum, mostly white sticky nocturnal sputum, sputum is related to the reflex mechanism of reflux stimulation, does not represent the existence of infection;

3. Symptoms of gastroesophageal reflux: Typical symptoms of reflux include burning sensation, acid reflux, belching, and chest tightness. Patients with GERD with slight aspiration are more prone to cough and pharynx symptoms at an early stage. There are also many patients with gastroesophageal reflux disease who have no reflux symptoms at all, and their only clinical manifestations when coughing. Cough mostly occurs during the day and in an upright position, with a dry cough or a small amount of white sticky sputum.

Reflux cough pathogenesis

Pathogenesis includes: direct countercurrent stimulation, airway microinhalation, vagus nerve reflex, etc.

1. Local irritation: In the absence of aspiration, cough is induced by stimulating the introduction of cough reflex by stimulating local mucosal irritation of the throat;

2. Inhalation irritation: Inhalation of the countercurrent irritates the lower respiratory tract and causes cough (a small amount of aspiration can cause pharyngitis and bronchitis; a large number of aspirations can cause lung aspiration syndrome, former pneumonia, pulmonary fibrosis, bronchiectasis, etc.)

3. Nerve reflex: stimulates esophageal-bronchial cough reflex to cause chronic cough. The acidic digestive juice in the stomach flows back into the lower part of the esophagus, stimulating the vagus nerve in the respiratory tract, causing smooth muscle spasms to occur and asthma.

Clinical diagnosis of reflux cough

Diagnosis should be combined with medical history, esophageal pH monitoring and treatment response.

Diagnostic criteria: 1. chronic cough, mainly daytime cough; 2. 24 hour esophagus pH monitoring Demeester score> 14.70; 3. exclusion of cough variant asthma (CVA), eosinophilic bronchitis (EB) postnasal drip Syndrome (PNDS) 4. Cough significantly reduced or disappeared after antireflux treatment.

The effectiveness of antireflux treatment is the most important criterion for the diagnosis of reflux cough, but the ineffectiveness of antireflux treatment does not completely rule out the existence of reflux cough, because the antireflux treatment may not be enough, or the medical treatment of medicine is ineffective, or Non-acid reflux. For patients who attach great importance to reflux cough, diagnostic treatment is feasible. Diagnostic treatment should last 1 to 3 months, and some patients even need 2 to 3 months to relieve cough.

Reflux cough test

Including barium meal examination, gastroscopy, esophageal pressure measurement, 24-hour pH monitoring of the esophagus, etc.

1. Barium meal examination: Upper gastrointestinal angiography (barium meal examination) is one of the easy methods to diagnose gastroesophageal reflux. If barium is observed to move from the stomach to the esophagus, gastroesophageal reflux can be observed. However, the specificity and sensitivity of barium meal tests were poor.

2. Gastroscopy: Electronic gastroscopy is the most direct evidence of erosive esophagitis in the presence of gastroesophageal reflux, which is found in pathological changes of the esophageal mucosa. About 60% of patients with post-sternal burning sensation, acid reflux and other symptoms found esophageal mucosal damage during gastroscopy. But not all gastroesophageal reflux can cause chronic cough;

3. Measurement of esophageal pressure: transient sphincter relaxation in the lower esophagus is an important cause of reflux;

4. 24-hour pH monitoring of the esophagus: Continuous monitoring of 24-hour esophageal pH in patients under physiological conditions using a pH recorder can provide objective evidence of excessive acid reflux in the esophagus. At present, 24-hour pH monitoring of the esophagus is considered to be the most important, The most sensitive diagnostic measure. By dynamically monitoring the change of esophageal pH, 6 parameters such as the number of times of esophageal pH <4 in 24 hours, the longest reflux time, and the percentage of esophageal pH> 4 in the monitoring time are obtained. Finally, the degree of reflux is expressed by Demeester points. The reflux-related symptoms were recorded to obtain the correlation probability of reflux and cough symptoms, and the relationship between the reflux phase and cough was clarified.

Reflux Cough Treatment

1. Medical treatment: The purpose of medical treatment is to reduce reflux and reduce stimulation and corrosion of gastric secretions. Sliding hernias without complaints generally do not require treatment. Patients with mild reflux esophageal inflammation or medical treatment due to age, other diseases, and unwillingness to surgery. For obese patients, weight loss can reduce intra-abdominal pressure and reflux. Avoid heavy movements, bending over, etc. Do not wear tights. Raise the head of the bed 15cm during sleep, do not eat 6h before bedtime, avoid alcohol and tobacco, can reduce the incidence of esophageal reflux.

In terms of drug treatment, antacids can be used to neutralize gastric acid and reduce the activity of pepsin. Gastric motility drugs such as domperidone (morpholine) can be used to prolong gastric emptying. H2 receptor antagonists or proton pump inhibitors can reduce gastric acid and protease secretion. Alginate can float on the surface of gastric juice to prevent reflux.

(1) Promote emptying of the esophagus and stomach

1. Dopamine antagonists such drugs can promote emptying of the esophagus and stomach and increase the tension of LES. Such drugs include metoclopramide (metoprolamide) and domperidone (domperidone), both 10 to 20 mg, 3 to 4 times a day, taken before bedtime and before meals. If the former is overdosed or taken for a long time, it can cause extrapyramidal neurological symptoms, so it should be used with caution in elderly patients; the latter can cause hyperprolactinemia with long-term administration, which can cause adverse reactions such as breast hyperplasia, lactation and amenorrhea.

2. Cisapride promotes peristalsis and emptying of the esophagus and stomach by releasing acetylcholine through the nerves of the intestinal plexus, thereby reducing gastroesophageal reflux. 10 to 20 mg, 3 to 4 times a day, almost no adverse reactions.

3 The pseudocholinergic drug bethanechol can increase the tension of LES, promote esophageal contraction, and speed up the emptying of acidic food in the esophagus to improve symptoms, 25mg each time, 3 to 4 times a day. This mouth can stimulate gastric acid secretion, so take it cautiously for a long time.

(B) reduce stomach acid

The antacid can neutralize gastric acid, thereby reducing the activity of pepsin and reducing the damage of acidic gastric contents on the esophageal mucosa. Alkaline drugs also have the effect of increasing LES tension. Two aluminum magnesium carbonate tablets, 3 to 4 times a day. Alginic acid foam (gariscon, alginate) contains alginic acid, sodium alginate and acid generator, which can float on the surface of gastric contents and prevent reflux of gastric contents.

Histamine H2 receptor antagonists: cimetidine, ranitidine, and famotidine can be selected, and the doses are 200mg, 3 4 / d; 150mg , 2 times / d and 30mg / d. The course of treatment was 6-8 weeks. This class of drugs can strongly inhibit gastric acid secretion and improve acid reflux in the gastroesophagus. If the above symptoms cannot be improved, the dose can be increased to 2 to 3 times.

Proton pump inhibitors: This class of drugs can block the H + -K + -ATPase of parietal cells, such as omeprazole and lansoprazole, which have been widely used in clinical practice, the former 20mg / d and the latter 30mg / d, can improve its symptoms.

(3) Combined use: Promote the combination of esophagus, gastric emptying drugs and antacids, which have a synergistic effect and promote the healing of esophagitis. Dopamine antagonists or cisapride may also be used in combination with histamine H2 receptor antagonists or proton pump inhibitors.

2. Endoscopic treatment: radiofrequency treatment of esophagus microcurrent.

3. Surgical treatment: The purpose of surgical treatment is to repair hernia holes and to counter reflux to correct esophageal stenosis.

Indications for surgery:

paraesophageal hiatal hernia

A hiatal hernia with reflux cough, repeated symptoms of which are not effective through medical treatment.

Serious complications such as recurrent respiratory tract inflammation, food ulcers, bleeding, and scar stenosis have occurred.

Compression or obstruction symptoms of giant hiatal hernia. Paraesophageal hiatal hernia can be repaired, and anti-reflux surgery should be performed to prevent reflux after surgery. The treatment of esophageal stenosis is first treated with dilation. If it is not effective, it must be treated with surgery.

Reflux Cough Prevention

1. Avoid overeating and develop a regular eating habit. Don't starve or eat. Overeating can cause the stomach bottom to swell, reflexively cause the lower esophagus sphincter to relax, and induce gastric acid reflux. Therefore, patients should eat less, eat more, three meals to 70% full is appropriate, if you feel hungry, add a small amount of snacks between meals, it is best not to eat before going to bed.

2. Avoid irritating foods. If irritating foods flow back to the esophagus, they can directly affect the inflammatory site and increase heartburn. On the other hand, there are many irritating foods, such as coffee, chocolate, alcohol, and mint, which can reduce the tension of the lower esophageal sphincter and slow gastric emptying. Fat, nicotine, nitroglycerin, etc. can also cause lower esophageal sphincter relaxation. Therefore, "heartburners" should quit smoking and alcohol, keep their diet light, and eat more vitamin-rich vegetables, fruits, and protein-rich fish, shrimp, poultry, eggs, and so on.

3 Avoid bed dilation immediately after meals in bed, which can cause the lower esophageal sphincter to relax. In order to digest food, the stomach secretes a large amount of gastric acid, which is most likely to cause reflux. If you lie down at this time, it will inevitably cause a large amount of gastric acid to flow back into the esophagus, aggravating esophageal damage. It is best to go to bed 3 hours after a meal, and wait for most of the food to be emptied from the stomach before going to bed. When sleeping, you should try to keep your head and feet low (30 & ordm; is appropriate).

4 Controlling obesity not only increases the burden on the heart, but also reduces the tension in the lower esophagus and increases the chance of gastric acid reflux. Obese people should actively control their weight, avoid high-fat diets, eat more fruits and vegetables, actively participate in outdoor activities, and exercise appropriately.

5. Maintaining an optimistic attitude and avoiding emotional tensions found that the incidence of heartburn among urban residents is much higher than that of rural residents. With the acceleration of people's pace of life and the increase of mental stress, long-term mental stress can affect the function of the lower esophageal sphincter and induce gastric acid reflux, so patients should always maintain an optimistic mood.