title: Review article: respiratory manifestations of gastro-oesophageal reflux disease.
abstract: BACKGROUND
  Respiratory manifestations represent one of the most prevalent and difficult-to-manage extra-oesophageal syndromes of gastro-oesophageal reflux disease.
  
  
  OBJECTIVE
  To review the epidemiology, pathophysiological mechanisms and therapeutic outcomes of reflux-related respiratory disorders.
  
  
  METHODS
  Search of the literature published in English using PubMed database.
  
  
  RESULTS
  There is a discrepancy between the high prevalence of reflux in asthmatics and the limited efficacy of antireflux therapies. Asthma per se may cause reflux. Patients with difficult-to-treat asthma and/or nocturnal symptoms should be screened for reflux. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and proton pump inhibitors in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Attention has been drawn to obstructive sleep apnoea syndrome.
  
  
  CONCLUSIONS
  The role of gastro-oesophageal reflux disease in the pathogenesis of miscellaneous respiratory disorders has been discussed for decades and established in asthma and cough. However, no major therapeutic advances have been reported recently. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring.
authors.affiliation: CHU Nantes, Service Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif and Institut National de Santé et de Recherche Médicale, Nantes, France. jeanpaul.galmiche@chunantes.fr
authors.forename: J P
authors.initials: JP
authors.lastname: Galmiche
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
authors.forename: S
authors.initials: S
authors.lastname: Bruley des Varannes
mesh_terms: D018927:Anti-Asthmatic Agents; D001249:Asthma / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002908:Chronic Disease; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D054328:Proton Pump Inhibitors; D012120:Respiration Disorders / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
chemical_list: D018927:Anti-Asthmatic Agents; D054328:Proton Pump Inhibitors