Gastroesophageal reflux disease in asthma: effects of medical and surgical antireflux therapy on asthma control.
OBJECTIVE
To critique the English-language reports describing the effects of medical and surgical antireflux therapy on respiratory symptoms and function in patients with asthma.


METHODS
The Medline computerized database (1959-1999) was searched, and all publications relating to both asthma and gastroesophageal reflux disease were retrieved.


RESULTS
Seven of nine trials of histamine-receptor antagonists showed a treatment-related improvement in asthma symptoms, with half of the patients benefiting. Only one study identified a beneficial effect on objective measures of pulmonary function. Three of six trials of proton pump inhibitors documented improvement in asthma symptoms with treatment; benefit was seen in 25% of patients. Half of the studies reported improvement in pulmonary function, but the effect occurred in fewer than 15% of patients. In the one study that used optimal antisecretory therapy, asthma symptoms were improved in 67% of patients and pulmonary function was improved in 20%. Combined data from 5 pediatric and 14 adult studies of anti-reflux surgery indicated that almost 90% of children and 70% of adults had improvement in respiratory symptoms, with approximately one third experiencing improvements in objective measures of pulmonary function.


CONCLUSIONS
Fundoplication has been consistently shown to ameliorate reflux-induced asthma; results are superior to the published results of antisecretory therapy. Optimal medical therapy may offer similar results, but large studies providing support for this assertion are lacking.
Bowrey
D J
DJ
Department of Surgery, University of Southern California, Los Angeles 90033-4612, USA.
Peters
J H
JH
DeMeester
T R
TR
D000328:Adult; D001249:Asthma / Q000209:etiology* / Q000517:prevention & control*; D002648:Child; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D054328:Proton Pump Inhibitors
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors