Bronchial asthma is a perverted response disease in the respiratory system. Its occurrence is closely related to its allergens and external allergens. It is a disease of different systems and stomach diseases, and it seems to be incompatible. However, it is reported that in the cause of endogenous asthma, gastroesophageal reflux has a very important position. The occurrence rate of gastroesophageal canopy in patients with asthma patients is about 30%-90%, which is significantly higher than that of ordinary people. 65%of the medium gastric esophageal reflux, 60%of those with gastroesophageal reflux with gastroesophageal reflux.
It can be seen that gastroesophageal reflux is a very important cause or factor that causes asthma. Asthma further aggravates the gastroesophageal reflux. The two affect each other and form a vicious circle. Clinically, asthma caused by gastroesophageal reflux is called “gastric asthma.”
The main pathological changes of the disease are caused by the reduction of the tension of the sphincter of the esophagus. The mechanism of causing asthma is unclear. There are currently three hypothetical:
① Direct stimulation: The reflux of the high -acid stomach content is inflow into the bronchial spasm.
② nerve reflex: The chemical sensor of one -third of the stimulating stimulation of the gastric acid stimulates the bronchial spasm through the vagus nerve reflection.
③ The acid sensitive effect of the pharynx: The pharynx is an ultra -sensitive chemical sensor of the pharynx, which is stimulated by gastric acid stimulation can cause throat and bronchial spasm.
The clinical characteristics of gastric asthma:
1. It is more common in middle -aged and elderly people. The symptoms and signs of typical gastroesophageal reflux are the most typical manifestations of gastric esophageal reflux. Antic acid is often acidic liquid or food from the stomach and esophagus to the pharynx or oral cavity when the meals are flexed or sleeping at night. The sense of heart burning or pain is also the main symptom of this disease. It occurs most of them in about 1 hour after a meal. The symptoms can disappear after the body flexion, lying on the back or side, and strenuous exercise; Excessive and acidic foods can increase the symptoms; some patients can also have difficulty swallowing.
2. Asthma hair is mostly at night, accompanied by nausea and indigestion, and asthma worsen during posture changes. There is no basic disease and typical signs of the heart and respiratory system.
3. Poor the treatment of heart -derived asthma and bronchial asthma.
4. Her cough and hissing before asthma.
In addition to “gastric asthma”, gastroesophageal reflux can also cause chronic cough of “unknown cause”. The mechanism of chronic cough is due to the reflux of gastric juice to the esophagus, and it can further reach the pharynx and turn into the trachea. The gastric juice stimulates the tracheal mucosa and causes cough. In addition, gastroesophageal reflux can also induce pseudo -angina pectoris, and many patients with gastroesophageal reflux will experience angina pectoris.
When asthma is accompanied by the symptoms of typical gastroesophageal reflux, the diagnosis is mostly difficult. However, some patients lack typical performance and often bring certain difficulties to diagnosis. When there is the following situations, the possibility of gastroesophageal reflux should be considered:
1. At night, the cough is cough, and those who have frequent asthma at night;
2. After meals (especially acidic foods or acidic beverages), asthma is prone to occur;
3. Cough and breathing are prone to occur after vomiting;
4. Those with symptoms of cough or asthma symptoms when the posture changes (bending down or lying position);
5. Those who use the bronchial extension or the symptoms are aggravated;
6. Refractory and asthma, that is, those who cannot find other causes when the bronchial dilated agent and hormone treatment are invalid or symptoms.
Anyone who has the above situation can be checked in gastric esophageal reflux. Among them, continuous monitoring of the PH value of the esophagus 24h is an important method for diagnosis of gastroesophageal reflux. The esophagus pH <4, if it lasts 10s, can be considered to have gastroesophageal reflux. If the continuous monitoring of the esophagus in the esophagus cannot confirm the gastric esophageal reflux, it can exclude its diagnosis.
When treating gastrointestinal asthma, we should use gastrointestinal power to reduce and eliminate airway non -specific inflammatory inflammation and reduce airway high response, anti -influx and acid anti -acid drugs to achieve significant effects.
1. Remove the inducement: Starting from changing lifestyle, such as exercise to help digestion, develop good eating habits, eat less spicy food, smoke and quit alcohol, reduce gastric storage, reduce the opportunity of esophageal reflux Do not eat in the first 4 hours, rest in bed after the stomach is empty, and raise the bedside 15 ° -20 ° to unlock the wide clothes to reduce abdominal pressure; ; Avoid lying flat immediately after eating.
2. Control the use of asthma drugs: A variety of asthma drugs such as catechine, β -injury agonist, antibroxyine, calcium antagonist, etc. can reduce the tension of LES and cause gastroesophageal reflux. Clinically, these drugs need to be used to treat asthma to weigh the advantages and disadvantages, avoid excessive dosage, and try to use inhalation and administration (the tension of LES during inhalation treatment is not obvious).
3. Actively treat gastroesophageal reflux: mainly use acid suppression and gastric dynamic drugs. The purpose of treatment is to reduce reflux, relieve symptoms, reduce the damage to the mucosa of the anti -stream substance, enhance the anti -flow defense function of the esophagus, and achieve healing the esophagus pipe. Inflammation, preventing recurrence, prevention and treatment of important complications.
Common drugs include:
① H2 receptor blockers, such as Simiidine, Renitidine, etc.;
② Proton pump inhibitors, such as omeprazole, Lanzozole, etc.;
③ Active pill, such as Dopanlidone, Sisha Billy, etc.;
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④ mucosal protective agent, such as sulfur and aluminum, has a mild buffer effect on gastric acid, aluminum carbonate can combine with reflux bile acid.⑤ Those who have not been effective after changing lifestyle and drug treatment can consider surgical treatment.