title: Respiratory disease and the oesophagus: reflux, reflexes and microaspiration.
abstract: Gastro-oesophageal reflux is associated with a wide range of respiratory disorders, including asthma, isolated chronic cough, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease and cystic fibrosis. Reflux can be substantial and reach the proximal margins of the oesophagus in some individuals with specific pulmonary diseases, suggesting that this association is more than a coincidence. Proximal oesophageal reflux in particular has led to concern that microaspiration might have an important, possibly even causal, role in respiratory disease. Interestingly, reflux is not always accompanied by typical reflux symptoms, such as heartburn and/or regurgitation, leading many clinicians to empirically treat for possible gastro-oesophageal reflux. Indeed, costs associated with use of acid suppressants in pulmonary disease far outweigh those in typical GERD, despite little evidence of therapeutic benefit in clinical trials. This Review comprehensively examines the possible mechanisms that might link pulmonary disease and oesophageal reflux, highlighting the gaps in current knowledge and limitations of previous research, and helping to shed light on the frequent failure of antireflux treatments in pulmonary disease.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA.|Centre for Gastrointestinal Sciences, University of Manchester, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Houghton
authors.affiliation: Division of Pulmonology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA.
authors.forename: Augustine S
authors.initials: AS
authors.lastname: Lee
authors.affiliation: Centre for Respiratory Medicine and Allergy, University of Manchester, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: Huda
authors.initials: H
authors.lastname: Badri
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: DeVault
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA.|Centre for Respiratory Medicine and Allergy, University of Manchester, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: Jaclyn A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000863:Antacids / Q000627:therapeutic use; D001980:Bronchi / Q000294:innervation; D004947:Esophagus / Q000294:innervation; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011015:Pneumonia, Aspiration / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D012120:Respiration Disorders / Q000150:complications; D012135:Respiratory Sounds / Q000209:etiology / Q000503:physiopathology; D019141:Respiratory System Agents / Q000009:adverse effects; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology; D013270:Stomach / Q000294:innervation
chemical_list: D000863:Antacids; D019141:Respiratory System Agents