Extraoeosophageal and gastrooesophageal reflux – relationship to asthma

Česká verzia

Authors: L. Heribanová
Authors place of work: Pneumologická klinika 1. LF UK a Thomayerova nemocnice, Praha
Published in the journal: Gastroent Hepatol 2016; 70(5): 438-442
Category: Vybrané kapitoly z vnitřního lékařství: přehledová práce
doi: https://doi.org/10.14735/amgh2016438

Summary

The coincidence of asthma and pathological gastrooesophageal or extraoesophageal reflux is common and the two diseases often adversely affect each other through different mechanisms. Clinical manifestations of pathological gastrooesophageal and extraoesophageal reflux may mimic asthma or affect the assessment of asthma control. The underlying mechanisms are the vagus nerve-mediated reflex, increased bronchial reactivity, microaspiration and alteration of the immune system response. In contrast, bronchial obstruction causes increased negative pleural pressure and affects the thoracoabdominal gradient. Systemic corticosteroids used in the treatment of severe asthma have a negative effect on reflux, while the adverse effect of other asthma medications is questionable. Every patient with asthma should be asked about reflux symptoms, although many of them do not present with any such problem. The methods that can be used in diagnosing gastrooesophageal and extraoesophageal reflux include esophagogastroduodenoscopy and two-channel 24-hour pH-measurement; typical signs of reflux can be detected by laryngoscopy and bronchoscopy. PH-measurement in the oropharynx and Peptest are less common tests. Another option is a diagnostic-therapeutic test. Apart from lifestyle and dietary changes, the mainstay of treatment for gastrooesophageal and extraoesophageal reflux are proton pump inhibitors and prokinetic agents, particularly suitable for the treatment of extraoesophageal reflux. Treatment of reflux positively influences asthma control.

Key words:
gastrooesophageal reflux – bronchial asthma – extraoesophageal reflux

The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
5. 9. 2016

Accepted:
3. 10. 2016

Zdroje

1. Teřl M, Čáp P, Dvořáková R et al. Doporučený postup diagnostiky a léčby bronchiálního astmatu. 1. vyd. Semily: GEUM 2015: 5–48.

2. Sedlák V, Chlumský J, Teřl M et al. Doporučený postup diagnostiky a léčby obtížně léčitelného bronchiálního astmatu 2011. [online]. Dostupné z: www.pneumologie.cz/guidelines/.

3. Lukáš K, Bureš J, Drahoňovský V. Refluxní choroba jícnu. Standardy České gastroenterologické společnosti – aktualizace 2009. Vnitr Lek 2009; 55 (10): 967–975.

4. Brandtl P, Lukáš K, Turzíková J. et al. Extraezofageální refluxní choroba – mezioborový konsenzus. Časopis lékařů českých 2011; 150 (9): 513–518.

5. Koufman JA. Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J 2002; 81 (9 Suppl 2): 7–9.

6. El-Serag HB, Sweet S, Winchester CC et al. Update on the epidemiology of gastrooesophageal reflux disease: a systematic review. Gut 2014; 63 (6): 871–880. doi: 10.1136/gutjnl-2012-304269.

7. Kašák V. Asthma bronchiale. In: Kolek V et al. Pneumologie. Praha: Maxdorf 2011: 149.

8. Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA 2005; 294 (12): 1534–1540.

9. Zeleník K, Komínek P, Chlumský J. Příručka pro praxi: Extraezofageální reflux. 1. vyd. Praha: Merck 2013: 4.

10. Issac M. The relationship between GERD and asthma. US Pharmacist 2009; 34 (7): 30–35.

11. Field SK. A critical review of the studies of the effects of simulated or real gastroesophageal reflux on pulmonary function in asthmatic adults. Chest 1999; 115 (3): 848–856.

12. Herve P, Denjean A, Jian R et al. Intraesophageal perfusion of acid increases the bronchomotor response to methacholine and to isocapnic hyperventilation in asthmatic subjects. Am Rev Respir Dis 1986; 134 (5): 986–989.

13. Dal Negro RW, Aubier M. Bronchial asthma and gastro-oesophageal reflux. In: Chung F, Fabbri LM. Asthma. Sheffield: ERS Journals 2003: 260–277.

14. Zeleník K, Komínek P. Extraezofageální reflux. Remedia 2010; 20: 398–401.

15. Kohata Y, Fujiwara Y, Machida H et al. Role of Th-2 cytokines in the development of Barrett’s esophagus in rats. J Gastroenterol 2011; 46 (7): 883–893. doi: 10.1007/s00535-011-0405-y.

16. Barbas AS, Downing TE, Balsara HE. Chronic aspiration shifts the immune response from Th1 to Th2 in a murine model of asthma. Eur J Clin Invest 2008; 38 (8): 596–602. doi: 10.1111/j.1365-2362.2008.01976.x.

17. Isomoto H, Nishi Y, Kanazawa Y et al. Immune and inflammatory responses in GERD and lansoprazole. J Clin Biochem Nutr 2007; 41 (2): 84–91. doi: 10.3164/jcbn. 2007012.

18. Zerbib F, Guisset O, Lamouliatte H et al. Effects of bronchial obstruction on lower esophageal sphincter motility and gastroesophageal reflux in patients with asthma. Am J Respir Crit Care Med 2002; 166 (9): 1206–1211.

19. Pomari C, Micheletto C, Turco P et al. Does i.v. theophylline increase gastro-esophageal reflux (GER) ? Am J Respir Crit CareMed 1997; 155 (4): 967.

20. Crowell MD, Zayat EN, Lacy BE et al. The effects of an inhaled beta2-adrenergic agonist on lower esophageal function: a dose-response study. Chest 2001; 120 (4): 1184–1189.

21. Pomari C, Michelleto C, Tognella S et al. Salbutamol MDI does not affect gastro-esophagel reflux. Am J Respir Crit CareMed 1997; 155 (4): 967.

22. Lazenby JP, Guzzo MR, Harding SM et al. Oral cortico steroids increase esophageal acid contact times in patients with stable asthma. Chest 2002; 121 (2): 625–634.

23. Sataloff R, Castell D, Katz P et al. Reflux laryngitis and related disorders. 3rd ed. San Diego: Plural Publishing 2005: 171.

24. Richter JE. Gastroesophageal reflux disease and asthma: the two are directly related. Am J Med 2000; 108 (Suppl 4a): 153S–158S.

25. Belafsky CP, Postma GN, Koufman JM. The validity and reliability of the reflux finding score. Laryngoscope 2001; 111 (8): 1313–1317.

26. Sweet MP, Patti MG, Hoopes C et al. Gastrooesophageal reflux and aspiration in patients with advanced lung dis- ease. Thorax 2009; 64 (2): 167–173. doi: 10.1136/thx.2007.082719.

27. Vaezi MF. Extraesophageal manifestations of gastroesophageal reflux disease. Clin Cornerstone 2003; 5 (4): 32–38.

28. Kroupa R, Ječmenová M, Dolina J. Terapie refluxní nemoci jícnu. Postgraduální medicína. Praha: Mladá fronta 2013; 15 (4): 435–439.

29. Galmiche JP. Non-erosive reflux disease and atypical gastrooesophageal reflux disease manifestations: treatment results. Drugs 2006; 66 (Suppl 1): 7–13.

30. Kiljander TO, Salomaa ER, Hietanen EK et al. Gastroesophageal reflux in asthmatics: a double-blind, placebo-controlled crossover study with omeprazole. Chest 1999; 116 (5): 1257–1264.

31. Dal Negro R, Pomari C, Micheletto C et al. Omeprazole (OM), but not placebo (P), reduces the bronchiale response to methacholine (MCH) in mild non-atopic asthmatics with gastroesophageal reflux (GER). Am J Respir Crit Care Med 1996; 153 (4): A517.

32. Harding SM. Gastroesophageal reflux and asthma: insight into the association. J Allergy Clin Immunol 1999; 104 (2 Pt 1): 251–259.

33. Belafsky CP, Postma GN, Amin RM et al. Symptoms and findings of laryngopharyngeal reflux. Ear, Nose & Throat Journal 2002; 81 (9): 10–13.