支气管扩张症中的反流：当前证据与临床意义。

文献信息

中文摘要

目的： 描述反流与支气管扩张症之间的关系，并评价近期关于支气管扩张症患者反流特征、临床结局和管理策略的文献。

近期发现： 反流在支气管扩张症中常见，并与更差的呼吸道症状和生活质量、更多急性加重和医疗资源使用、更低的肺功能以及更高的死亡率相关。这些关联在多个队列中均可见，但几乎所有数据均为观察性研究，使用不同的反流定义，无法确定反流是促进支气管扩张症进展，还是仅仅识别出病情更严重的患者。提出的通路包括微吸入相关气道损伤、反射介导的咳嗽放大以及微生物失调。尚无随机支气管扩张症特异性试验显示针对反流的治疗可改善呼吸结局，而单纯抑酸不太可能解决非酸性反流、微吸入、咳嗽反射通路或气道失调。

总结： 在支气管扩张症中，应将反流分为临床相关表型，包括典型胃食管反流病、近端或非酸性反流、喉咽症状、吞咽困难和误吸。管理应根据疑似反流或误吸模式进行指导，因为单纯抑酸可能无法解决与气道相关的反流。未来研究应将客观反流和吞咽测量与支气管扩张症特异性结局配对。

英文摘要

PURPOSE OF REVIEW: To describe the relationship between reflux and bronchiectasis and to appraise recent literature on reflux characterization, clinical outcomes, and management strategies in patients with bronchiectasis.
RECENT FINDINGS: Reflux is common in bronchiectasis and has been linked to worse respiratory symptoms and quality of life, more exacerbations and healthcare use, lower lung function, and higher mortality. These associations are seen across several cohorts, but nearly all data are observational, use variable reflux definitions, and cannot determine whether reflux contributes to bronchiectasis progression or simply identifies patients with more severe disease. Proposed pathways include microaspiration-related airway injury, reflex-mediated cough amplification, and microbial dysbiosis. No randomized bronchiectasis-specific trial has shown improved respiratory outcomes with reflux-directed therapy, and acid suppression alone is unlikely to address nonacid reflux, microaspiration, cough-reflex pathways, or airway dysbiosis.
SUMMARY: In bronchiectasis, reflux should be separated into clinically relevant phenotypes, including typical gastroesophageal reflux disease, proximal or nonacid reflux, laryngopharyngeal symptoms, dysphagia, and aspiration. Management should be guided by the suspected reflux or aspiration pattern because acid suppression alone may not address airway-relevant reflux. Future studies should pair objective reflux and swallowing measures with bronchiectasis-specific outcomes.