Gastroesophageal reflux disease and its consequences.
Gastroesophageal reflux is a common event characterized by orad movement into the esophagus of gastric and/or duodenal contents. Reflux may produce either no damage to the esophageal mucosa or erosions, exudates, ulcerations, strictures, and/or Barrett's (columnar-lined) esophagus. In addition to the esophagus, all the anatomic structures from the pharynx to the lung may be affected by reflux. Numerous factors promote abnormal esophageal mucosal contact time with acid and pepsin. These include incompetent lower esophageal sphincter, impaired esophageal clearance, increased frequency of reflux episodes, delayed gastric emptying, and the presence of a hiatal hernia. The relative contribution of each of these factors in the pathogenesis of esophageal mucosal disease has not been clearly defined. Epidemiologic and clinical data support an association between gastroesophageal reflux and pulmonary disease. Most asthmatic patients, independent of bronchodilator use, have evidence of gastroesophageal reflux, as demonstrated by ambulatory pH testing, endoscopy, and the presence of reflux symptoms. Studies with antireflux agents indicate that partial or complete symptom relief and healing of esophagitis are obtained in about half the patients using H2-receptor antagonists and almost all patients using omeprazole. Preliminary evidence suggests that surgical correction of reflux may lead to improved pulmonary status. Controlled clinical trials are needed, however, to further determine whether effective gastric acid suppression will improve reflux-associated pulmonary disease.
Sontag
S J
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Department of Ambulatory Care, Edward Hines, Jr, Hospital, Department of Veterans Affairs, Illinois 60141.
D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D012008:Recurrence