Asthma and gastroesophageal reflux: clinical evaluation of esophago-bronchial reflex and proximal reflux.
OBJECTIVE
To evaluate the prevalence of proximal reflux and esophago-bronchial reflex (EBR) in patients with asthma, and to compare the symptom spectrum, esophageal acid sensitivity, pH monitoring, and the endoscopic and manometric parameters of EBR-positive and -negative patients with asthma.


METHODS
Forty-three consecutive patients with recent diagnoses of asthma and 20 patients with chronic cough but without asthma were prospectively submitted to detailed reflux and respiratory symptom analysis, upper gastrointestinal endoscopy, esophageal manometry, Bernstein test and double-channel intra-esophageal pH monitoring. The presence of EBR was studied by combined esophageal acid (0.1 N HCl) perfusion and methacholine test.


RESULTS
Patients with asthma had significantly more proximal acid reflux than controls. Patients with EBR positivity were more likely to have an acid-sensitive esophagus and had more acid reflux especially in the supine period at the distal measurement point. Other parameters were similar.


CONCLUSIONS
Patients with asthma had significantly more proximal acid reflux than those with chronic cough. The combination of the methacholine test with esophageal acid perfusion is able to establish the presence of EBR, however prospective therapeutic trials are needed to confirm its clinical value. The increased amount of acid reflux during the supine period in patients with EBR may indicate a role for appropriate nighttime acid suppressive therapy.
Rosztóczy
András
A
First Department of Medicine, Albert Szent-Gyorgyi Medical Centre, University of Szeged, Szeged, Hungary. air@in1st.szote.u-szeged.hu
Makk
László
L
Izbéki
Ferenc
F
Róka
Richárd
R
Somfay
Attila
A
Wittmann
Tibor
T
D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology*; D001980:Bronchi / Q000503:physiopathology; D015897:Comorbidity; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012018:Reflex / Q000502:physiology