title: Does gastroesophageal reflux increase chronic obstructive pulmonary disease exacerbations?
abstract: The relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations.
  
  
  
  We included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study.
  
  
  
  According to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p < 0.001).
  
  
  
  In our study, gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD.
authors.affiliation: Koç University Hospital, Department of Pulmonology, Istanbul, Turkey. Electronic address: snmkaraosman@gmail.com.
authors.forename: Sinem
authors.initials: S
authors.lastname: Iliaz
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: raimiliaz@gmail.com.
authors.forename: Raim
authors.initials: R
authors.lastname: Iliaz
authors.affiliation: Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Istanbul, Turkey. Electronic address: sedatural@yahoo.com.
authors.forename: Seda Tural
authors.initials: ST
authors.lastname: Onur
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: aserpilarici@gmail.com.
authors.forename: Serpil
authors.initials: S
authors.lastname: Arici
authors.affiliation: Fatih Sultan Mehmet Educational and Research Center, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: umitakyuz@yahoo.com.
authors.forename: Umit
authors.initials: U
authors.lastname: Akyuz
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: cetinkaraca@yahoo.com.
authors.forename: Cetin
authors.initials: C
authors.lastname: Karaca
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: kadirdmr@yahoo.com.
authors.forename: Kadir
authors.initials: K
authors.lastname: Demir
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: besisiksef@yahoo.com.
authors.forename: Fatih
authors.initials: F
authors.lastname: Besisik
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: kaymakoglus@hotmail.com.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Kaymakoglu
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey. Electronic address: filizakyuz@hotmail.com.
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyuz
mesh_terms: D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: COPD; Exacerbation; Gastroesophageal reflux; HRM; Impedance; pH monitoring