Gastroesophageal reflux: a common exacerbating factor in adult asthma.
There is a unique yet common relationship between gastroesophageal reflux (GER) and asthma. This paper's discussion covers the lower esophageal sphincter (LES) and other components that form the anti-reflux barrier and how the barrier can be breached. There are three predominant theories on the asthma/GER connection; (1) the inhalation of microaspirate into the lungs causes an inflammatory response, (2) a vagally mediated reflex pathway occurring when acid is present in the esophagus, and (3) a combination of the first two theories. Available diagnostic tests for GER include the "gold standard," the 24-hour ambulatory pH monitor. Adult asthmatic patients with GER can present with atypical symptoms such as worsening nocturnal asthma or hoarseness and not have a single classic symptom like heartburn. Treatment is implemented in a step-wise approach first using education to introduce conservative anti-reflux measures, progressing to pharmacotherapy (acid suppressive agents and promotility agents) and finally surgical correction like the Nissen fundoplication to create a competent anti-reflux barrier, thus achieving improved asthma management.
Sullivan
C A
CA
University of Utah Health Sciences Center, Salt Lake City, USA.
Samuelson
W M
WM
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology*; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009730:Nursing Assessment; D012307:Risk Factors
D000897:Anti-Ulcer Agents