Gastroesophageal Reflux and Asthma: Can the Paradox Be Explained? (original) (raw)
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Gastroesophageal Reflux Disease in Asthma
Annals of Surgery, 2000
To critique the English-language reports describing the effects of medical and surgical antireflux therapy on respiratory symptoms and function in patients with asthma. PATHOPHYSIOLOGY OF REFLUX-INDUCED ASTHMA Two mechanisms have been proposed as the pathogenesis of reflux-induced asthmatic symptoms. The first, the socalled "reflux" theory, maintains that respiratory symptoms are the result of the aspiration of gastric contents. The
Effects of Asymptomatic Proximal and Distal Gastroesophageal Reflux on Asthma Severity
American Journal of Respiratory and Critical Care Medicine, 2009
Rationale: Silent gastroesophageal reflux (GER) is common in patients with asthma, but it is unclear whether GER is associated with worse asthma symptoms or reduced lung function. Objectives: To determine in patients with poorly controlled asthma, whether proximal or distal esophageal reflux is associated with asthma severity, symptoms, physiology, or functional status. Methods: Baseline asthma characteristics were measured in patients with asthma enrolled in a multicenter trial assessing the effectiveness of esomeprazole on asthma control. All participants underwent 24-hour esophageal pH probe monitoring. Lung function, methacholine responsiveness, asthma symptoms, and quality-of-life scores were compared in subjects with and without GER. Measurements and Main Results: Of 304 participants with probe recordings, 53% had reflux. Of 242 participants with recordings of proximal pH, 38% had proximal reflux. There was no difference in need for short-acting bronchodilators, nocturnal awakenings, dose of inhaled corticosteroid, use of long-acting b-agonists, lung function, or methacholine reactivity between individuals with and without proximal or distal GER. Participants with GER reported more use of oral corticosteroids and had worse asthma quality of life and subjects with proximal GER had significantly worse asthma quality of life and health-related quality of life compared with participants without GER. Conclusions: Asymptomatic GER is not associated with distinguishing asthma symptoms or lower lung function in individuals with suboptimal asthma control who are using inhaled corticosteroids. Patients with proximal reflux report significantly worse asthma and health-related quality of life despite lack of physiologic impairment or increase in asthma symptoms. Clinical trial registered with www.clinicaltrials.gov (NCT00069823).
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.
Background: Gastroesophageal reflex is known as an acid reflex, is long term condition where stomach contents back into the oesophagus resulting in either symptoms or complications. GERD disease is caused by weakness or failure of the lower oesophageal sphincter. Symptoms include the acidic taste behind the mouth, heart burn, chest pain, difficult breathing and vomiting. Complication includes esophagitis, oesophageal strictures and barrettes oesophagus. Objective: The aim of this research was to introduce the symptoms of GERD disease in asthmatic patients and how these symptoms worsen the symptoms of asthma disease and what clinical pictures present with the asthmatic disease. Methodology: A designed performa was used to collect the data and after filling the performa, results were drawn and conclusion through the facts and the information given by patients. Results: In the present study among all 164 asthmatic patients, 70 (42.7%) patients showed dyspepsia, 58 (35.4%) were with chest burning, 23 (14%) were asking about chest pain, with acidic mouth taste were 39 (23.8%), 22 (13.4%) were feeling sore throat and 44 (26.8%) showed regurgitation reflex. Among these 164 patients 16 (9.8%) were smokers and 148 (90.2 %) were non-smokers. 47 (28.7%) were males and 117 (71.3%) were females. Conclusion: It is concluded that gastroesophageal reflux disease in asthmatic patients present symptoms of acidic mouth taste, chest burning, chest pain, dyspepsia, regurgitation reflex and sore throat.
The Prevalence of Gastroesophageal Reflux Disease in Adult Asthmatics
Chest, 2004
Background: Asthma and gastroesophageal reflux disease (GERD) often coexist. However, the results of the studies investigating the prevalence of GERD among patients with asthma vary greatly. Study objective: To investigate the prevalence of GERD in adult patients with asthma. Subjects and methods: The basic study population consisted of 2,225 asthmatic patients who were treated in six specialist-headed hospitals during 1 year. From the common computer-based discharge register, every 14th patient was randomly selected for the study. Ninety of the 149 contacted patients (60%) agreed to participate in the study. Twenty-four-hour esophageal pH monitoring was performed on all patients. Results: GERD was found in 32 of the patients (36%). Eight of these patients (25%) were free from classical reflux symptoms. Forty-seven of the 90 patients (52%) presented with typical reflux symptoms. Twenty-four of these patients (51%) were found to have abnormal acidic reflux. Conclusions: According to the current study, one third of adult patients with asthma have GERD. These patients often do not have typical reflux symptoms. However, the presence of typical reflux symptoms in an asthmatic patient does not seem to guarantee the presence of abnormal acidic reflux.
Multidisciplinary Respiratory Medicine, 2012
Background: The prevalence of Gastroesophageal Reflux Disease (GERD) in Turkey is reported as 11.6%. Studies of pulmonary function in asthmatics have demonstrated a correlation between lung resistance and the occurrence of spontaneous gastroesophageal reflux. Few studies have included measures of lung diffusing capacity for carbon monoxide. The aim of this study is to assess whether asthma patients had worse lung function and gas diffusion according to diversity of GERD symptoms they concurrently experienced. The secondary aim of the study is to determine the frequency and different faces of GERD in our asthma patients compared to healthy controls. Methods: Sixty consecutive asthma patients evaluatd at the pulmonary specialty outpatient clinic were included in the study. The control group included 60 healthy volunteers who had normal pulmonary function and routine laboratory tests. A modified version of a self-reported questionnaire developed by Locke and associates at the Mayo Clinic was conducted face-to-face with consecutive asthma patients and control subjects. Pulmonary function measurements were taken using spirometry. DLCO (mL/dk/mmHg) and DLCO/VA (DLCO adjusted according to alveolar volume) were measured using a single-breath technique. Statistical analyses were performed using the SPSS 17.0 statistical software.
Journal of Cardiovascular and Thoracic Research, 2014
Almost one third of patients with asthma have symptomatic evidence for coexisting gastroesophageal reflux disease (GERD), which is thought to be aggravating factor in asthma at least in some cases. We investigated the impact of coexisting GERD on asthma severity and parameters of lung function. Methods: Ninety two asthma patients diagnosed according to ATS criteria were studied. After full history and physical examination, asthma severity was measured in each patient using asthma control test (ACT). GERD symptoms was verified in each patient. Impulse oscillometry (IOS) and lung volume studies (using body-plethysmography and IOS) were performed. The difference between total airway resistance (TAWR) indicated by resistance at 5 Hz and central airway resistance (CAWR) as indicated by resistance at 20 Hz in oscillometry was calculated and considered as representative of resistance at peripheral airways (PAWR). The relationship between the presences of GERD symptoms, ACT score and parameters of lung function were analyzed. Results: PAWR and TAWR were both significantly higher in asthmatic patients with GERD symptoms than patients without GERD symptoms (256.64±161.21 versus 191.68±98.64; P=0.02, and 102.73±122.39 versus 56.76±71.43; P=0.01, respectively). However, no significant difference was noted in mean values of ACT, FEV1 (forced expiratory volume in 1 sec), FVC (forced vital capacity), PEF (peak expiratory flow), and CAWR in these two groups. Conclusion: These findings suggest that the severity of asthma as measured by ACT score is not different in patients with and without GERD symptoms. However, total and peripheral airway resistance measured by IOS is significantly higher in asthmatic patients with GERD symptoms.