Gastroesophageal reflux-induced bronchoconstriction. An intraesophageal acid infusion study using state-of-the-art technology (original) (raw)
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The American Journal of Medicine, 2001
Although a strong association exists between gastroesophageal reflux (GER) and asthma, results of studies designed to maximize the likelihood of identifying that GER worsens pulmonary function in patients with asthma have been negative or inconclusive. Asthma symptoms worsen during symptomatic reflux episodes, and asthma symptom severity correlates with the severity of symptomatic reflux. Various reasons have been proposed to explain these findings. Discomfort associated with GER can cause reflux-associated respiratory symptoms even when pulmonary function is normal. New findings suggest that increases in minute ventilation rather than inhibition of diaphragm activity are responsible for the changes in respiratory sensation during acid perfusion of the esophagus in nonasthmatic subjects. These results may also pertain to asthmatic patients, because increasing minute ventilation can cause dyspnea and bronchospasm in this population. Treating GER, either medically or surgically, may improve asthma symptoms by preventing GER-induced changes in minute ventilation.
Further investigation of the association between gastroesophageal reflux and bronchoconstriction
Journal of Allergy and Clinical Immunology, 1982
A double-blind modification of the intraesophageal acid perfusion challenge (Bernstein procedure) was pet$ormed in asthmatic subjects with and without gastroesophageal reflux, nonasthmatic subjects with re+, and normal subjects. Conventional spirometric functions and total respiratory resistance (Rrs) were measured prior to and after the infusion. There were no changes in pulmonary functions except in the asthmatic subjects who had had a positive acid challenge. The greatest changes occurred in Rrs, which increased significantly with reflux symptoms (p < 0.01) and decreased toward baseline (p < 0.05) when these symptoms were relieved with antacids. The response was even greater in asthmatic subjects who associated ref?ux symptoms with attacks of asthma. These results support previous findings that acid reflux symptoms could cause a bronchoconstrictive response in certain asthmatic patients. (J ALLERGY CLIN IMMUNOL 69:516, 1982.)
Airway acidification and gastroesophageal reflux
Current Allergy and Asthma Reports, 2008
Although challenging to study, researchers recently recognized the relevance of airway pH to the pathophysiology of several respiratory diseases, ranging from asthma and cystic fibrosis to pneumonia. The airway epithelium is extraordinarily sensitive to acid. Gastroesophageal reflux can and does cause respiratory symptoms, through both neurally mediated pathways and direct aspiration. Direct aspiration has a variety of immunologic, biochemical, and physiologic effects that aggravate asthma and other respiratory diseases, yet strategies to diagnose and treat gastroesophageal refluxrelated respiratory symptoms remain imprecise.
Simultaneous tracheal and esophageal pH monitoring: Investigating reflux-associated asthma
The Annals of Thoracic Surgery, 1993
Aspiration of gastric acid into the trachea may cause asthma in some patients who have gastroesophageal reflux. Antireflux surgery has been advocated for such patients, but lack of an objective test for acid aspiration makes patient selection difficult. We report a new technique for demonstrating acid aspiration, simultaneous tracheal and esophageal pH monitoring. Tracheal pH was measured with a 1.0-mm pH electrode introduced through the cricothyroid membrane under bronchoscopic vision. A standard esophageal pH electrode was placed in the usual position. Tracheal and esophageal pH were monitored over a 24-hour period. Peak expiratory flow n association between gastroesophageal reflux and A asthma is now well recognized [l], although the pathophysiology underlying the association has been difficult to investigate. Two theories are proposed: aspiration of refluxed gastric contents and neurogenic reflex bronchoconstriction stimulated by esophageal exposure to acid. Evidence for and against these theories has been reviewed recently .
CHEST Journal, 1999
To identify and critically review the published peer-reviewed, English-language studies of the effects of both spontaneous and simulated gastroesophageal reflux (GER) on pulmonary function in asthmatic adults. Design: Using the 1966 to 1997 MEDLINE database, the terms asthma and lung disease were combined with GER to identify studies of the effects of GER and acid perfusion (AP) of the esophagus on pulmonary function. The bibliographies were also reviewed. Studies of asthmatics with and without symptomatic GER were analyzed both together and separately. Results: A total of 254 citations, including 180 published in English, were identified. Among these were 18 studies of GER and AP in asthmatic adults. These reports, which contain data on 312 asthmatics, found that the FEV 1 and the midexpiratory rate did not change during AP and GER in the studies containing 97% and 94% of the asthmatics, respectively. Flow volume loop indexes, including the flow at 50% of the vital capacity (V 50), flow at 25% of the vital capacity, and the peak expiratory flow rate, did not change during AP or GER in the studies with 77%, 60%, and 65% of the asthmatics, respectively. Small changes in the resistance were reported in the studies containing 42% of the asthmatics. Among asthmatics without symptomatic GER, no changes in spirometry, resistance, and flow volume indexes were found, except for a 10% decline in V 50 in one study with seven subjects. Conclusions: In asthmatics with GER, the effects of AP on pulmonary function are minimal, and only a minority are affected. The literature does not support the conclusion that asymptomatic reflux contributes to worsening lung function.
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2013
The association of gastro-esophageal reflux (GER) with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR) in patients and the response to treatment. In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. There was a significant difference in the rate of positive methacholine test between the cases (40%) and the controls (6.7%) prior to anti-acid therapy (P < 0.0001). After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05) but did not change in the con...
Digestive Diseases and Sciences, 2005
A number of factors have been proposed to account for the lack of response to medical therapy in patients with gastroesophageal reflux; however, no controlled studies are available in the literature. The goal of this study was to determine possible causes of medical refractoriness in patients with gastroesophageal reflux. Gastric acid output and esophageal acid exposure were measured in patients who continue to have reflux symptoms despite aggressive antisecretory therapy. In addition, an upper endoscopy was also performed in each patient. Patients with a drug-controlled acid output <1 mEq/hr and a supine total esophageal pH < 4 for less than 1.7% of the time measured were considered responsive to therapy; on the other hand, those with a drug-controlled gastric acid output >1 mEq/hr and a supine esophageal pH < 4 for more than 1.7% of the time measured were considered resistant to therapy. Twenty -four patients met the inclusion criteria (13 male and 11 female; mean age, 52). Drugcontrolled gastric acid output was more than 1 mEq/hr in 25% of patients and less than 1 mEq/hr in the remainder. Of those patients with a gastric acid output of less than 1 mEq/hr (18 patients), 8(44%) had a supine esophageal pH < 4 for more than 1.7% of the time, suggesting that factors other than gastroesophageal reflux likely contributed to their reflux-like symptoms. Acid suppression appears adequate in the majority of patients with gastroesophageal reflux refractory to medical therapy. The exact cause of persistent reflux-like symptoms in patients who fail medical treatment is uncertain but may be related to non-acid-related factors such as esophageal hypersensitivity to physiologic reflux, increased intake of air resulting in aerophagia, or other factors such as bile reflux.