喘息症状を伴った胃食道逆流症に対しlaparoscopic Nissen fundoplicationが著明に奏効した1例

A Case of Gastroesophageal Regurgitation with Symptoms of Asthma that was Markedly Improved by Laparoscopic Nissen Fundoplication

　症例は71歳・女性・60歳頃より喘息発作．乾性咳を認め，咳嗽発作で意識消失を起こすことがあり当院に受診した．呼吸器精査では咳嗽の原因はなく，咳嗽の増悪に比例し胸やけが増悪していることが判明した．消化器内視鏡検査では滑脱型食道裂孔ヘルニアと逆流性食道炎を認めた．24時間食道pHモニタリングでpH＜4となる時間は約28.4％で，pH＜4が続くと咳嗽発作が生じた．以上から本例は胃食道逆流症（以下，GER）による喘息，慢性持続性咳噺（以下，CPC）と診断した．薬物治療は効果不十分でlaparoscopic Nissen fundoplicationを行った．術後は逆流性食道炎，喘息，CPCは著明に改善した．本邦では稀であるが，GERは喘息やCPCの重要な素因の1つであり，今後，呼吸器内科との連携により手術適応となる症例は増加するものと予想される．

A 71-year-old female was brought to our hospital with a history of asthma attacks and coughing attacks with unconsciousness. Detailed examination of respiratory organs revealed no cause of cough, but it was shown that heartburn was aggravated proportionally to the cough. Endoscopic examination demonstrated sliding esophag-eal hiatal hernia and regurgitant esophagitis. In a 24-hour esophageal pH monitoring, the time of pH<4 was ap-proximately 28.4%. When pH<4 continued, coughing attacks occurred. Based on the above findings, the patient was diagnosed as having asthma and chronic persistent cough due to gastroesophageal regurgitation.