Gastroesophageal reflux and bronchial responsiveness: correlation and the effect of fundoplication.
BACKGROUND
A causal relationship between gastroesophageal reflux (GER) and asthma has been suggested. Should this be the case, one could expect treatment of GER to diminish bronchial sensitivity. There has been a lack of trials evaluating the efficacy of antireflux surgery on airway reactivity.


OBJECTIVE
To investigate the correlation between GER and bronchial responsiveness, and to determine the efficacy of Nissen fundoplication on bronchial responsiveness and pulmonary function.


METHODS
A methacholine inhalation challenge was performed on 15 consecutive GER patients preoperatively and approximately 5 months after Nissen fundoplication. Airway responsiveness was quantified with a dose-response slope (DRS), calculated by dividing the decrease in FEV(1) (%) with the dose of methacholine administered (micromoles).


RESULTS
A positive correlation between the severity of distal esophageal reflux and bronchial responsiveness was found (r = 0.83, p < 0.001). There was an improvement in FEV(1) after fundoplication (p = 0.03). All 3 asthmatic patients participating in the study presented with bronchial hyperresponsiveness (BHR) which improved clearly in all of these patients after fundoplication. This resulted in an apparent trend for DRS to improve when the entire study population was considered (p = 0.12).


CONCLUSIONS
According to the current study there seems to be a positive correlation between the severity of distal esophageal reflux and bronchial responsiveness. These data suggest that operative treatment of GER may ameliorate BHR in asthmatic patients. Moreover, the results of the present study suggest that fundoplication may improve pulmonary function in patients with GER.
Kiljander
Toni O
TO
Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland. toni.kiljander@koti.soon.fi
Salomaa
Eija-Riitta M
ER
Hietanen
Eino K
EK
Ovaska
Jari
J
Helenius
Hans
H
Liippo
Kari
K
D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000150:complications* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000209:etiology / Q000601:surgery*; D016085:Bronchoconstrictor Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008433:Mathematics; D016210:Methacholine Chloride / Q000008:administration & dosage; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride