The relation of GERD, bronchial asthma and symptomatology from ear, nose and throught regions

Czech version

Authors: Z. Matyášová ¹; B. Novotná ²; M. Matulová ³; Jiří Dolina ¹; R. Kroupa ¹; Z. Láníková ⁴; V. Znojil ⁵; A. Hep ¹; Petr Dítě ¹
Authors‘ workplace: Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. ¹; Alergologické oddělení Interní gastroenterologické kliniky Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. ²; ORL oddělení FN Brno, pracoviště Bohunice, přednosta prim. MUDr. Aleš Trnka ³; Viameda, s. r. o., ambulance alergologie a klinické imunologie, Brno, ředitelka RNDr. Veronika Vlčková ⁴; Ústav patologické fyziologie Lékařské fakulty MU, Brno, přednosta prof. MUDr. Anna Vašků, CSc. ⁵
Published in: Vnitř Lék 2005; 51(12): 1341-1350
Category: Original Contributions

Overview

Gastroesophageal reflux disease (GERD) is one of the most common diseases affecting upper gastrointestinal tract. It is a chronic disease, whith stadily growing incidence and prevalence in west countries during last 30 years. GERD is caused by pathologic gastroesophageal reflux (GER). GERD includes endoscopically positive, endoscopically negative and extraesophageal reflux disease. Extraesophageal symptoms of GERD have been of a growing attention and discussion during last few years. The most discussed topics are the relation of GERD and bronchial asthma (BA), chronic cough and symptomatology from ear, nose and throught (ENT) regions, but also non - cardial chest pain and many others.

Aim:
In our clinic we ran a 5 years study which aim was to evaluate the presence of GERD in patients with bronchial asthma, chronic cough and affections from ENT regions. To assess if 3 months GERD treatment would improve lung function, subjective complaints (cough) and GERD control in asthmatics; if this treatment would allow to step - down with antiasthma medication. To assess if 3 months GERD treatment can improve objective and subjective assessments in patients with chronic cough and findings in ENT regions. As for GERD, we evaluated the improvement of pH and subjective complaints (pyrosis).

Methods:
We examined 86 patients with different severity of bronchial asthma, 54 patients with chronic cough and 31 patients with ENT symptoms. All patients underwent 24 hour esophageal pH metry, spirometry with lung function evaluation and objective ENT examination by flexible laryngoscopy. In case of pathologic finding on 24 hour pH-metry 3 months full antireflux treatment with proton pump inhibitors (PPI) and prokinetics was introduced. After 3 months of GERD treatment we performed control 24 hour esophageal pH metry, control spirometry and ENT examination by flexible laryngoscopy. Patients were asked to make their subjective symptoms assessments.

Results:
We found that GERD prevalence in patients with respiratory symptoms was very high. Three months GERD treatment improved lung function (FEV₁) with statistical significance (p = 0.0319), and so improved GERD control (in 60.7 % of patients with high statistical significance p = 0.0009). Subjective complaints (cough) also improved in most patients. 3 months GERD treatment did not allow to step down with maintenance BA therapy according to GINA guidelines, but it enabled to decrease the rescue medications in 50 % of patients. Patients with chronic cough can benefit from GERD treatment as cough improved in 75.8 % of patients.

Conclusion:
Objective findings as well as subjective complaints improved in 75 % of patients with ENT symptomatology. GERD control (DeMeester score and pyrosis if present) was highly statistically significant in all three groups of patients. It is necessary to mention, that there is a high presence of nocturnal acid breakthrough (NAB) in patients with respiratory symptoms: 30.3 % in patients with bronchial asthma, 63.6 % in patients with chronic cough and 45 % of patients with ENT manifestations.

Key words:
gastroesophageal reflux - bronchial asthma - cough - ENT - proton pump inhibitors - prokinetics - pH-metry - nocturnal acid breakthrough

Sources

1. Al-Sabbagh G, Wo JM. Supraesophageal Manifestations of Gastroesophageal reflux Disease. Seminars in Gastrointestinal disease 1999; 10: 113-119.

2. Bauman NM, Sandler AD, Schmidt C et al. Reflex laryngospasm induced by stimulation of distal esophageal afferents. Laryngoscope 1994; 104: 209-214.

3. Beauvillain de Montreuil C. Pharyngitis, laryngitis in the adult and gastroesophageal reflux. In: Giuli R, Galmiche JP, Jamieson Glynn G et al (Eds). O.E.S.O. - The esophagogastric junction. Paris: John Libbey Eurotext 1998: 583-584.

4. Benini L, Ferrari M, Sembenini C et al. Cough threshold in reflux oesophagitis: influence of acid and of laryngeal and oesophageal damage. Gut 2000; 46: 762-767.

5. Bohadana AB, Hannhart B, Teculescu DB. Nocturnal Worsening of asthma and sleep-disordered breathing. Journal of Asthma 2002; 39: 85-100.

6. Borkowski G, Sommer P, Stark T et al. Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children. Eur Arch Otorhinolaryngol 1999; 256: 370-372.

7. Bove M, Ruth M, Cange L et al. 24-H Pharyngeal pH Monitoring in Healthy Volunteers: A Normative Study. Scand J Gastroenterol 2000; 3: 234-241.

8. Bretza J, Novey HS. GE reflux and asthma. West J Med 1979; 131: 320.

9. Close LG. Laryngopharyngeal manifestations of reflux: diagnosis and therapy. European Journal of Gastroenterology and Hepatology 2002; 14(Suppl): S23-S27.

10. Čáp P, Vondra V. Definice a výskyt kašle. In: Čáp P, Vondra V. Kašel: Obranný mechanismus, příznak, terapie. Praha: Galerie Vltavín 2000: 7.

11. Čáp P, Vondra V. Chronický kašel (etiologie, diagnostika, terapie). In: Čáp P, Vondra V. Kašel: Obranný mechanismus, příznak, terapie. Praha: Galerie Vltavín 2000: 11-21.

12. Špičák V, Kašák V, Pohunek P. Definice. In: Špičák V, Kašák V, Pohunek P. Globální strategie péče o astma a jeho prevenci. Praha: Česká iniciativa pro astma, Jalna 2003: 1-28.

13. Špičák V, Kašák V, Pohunek P. Diagnóza a klasifikace. In: Špičák V, Kašák V, Pohunek P. Globální strategie péče o astma a jeho prevenci. Praha: Česká iniciativa pro astma, Jalna 2003: 73-86.

14. Fennerty MB. Extraesopgaheal Gastroesophageal Reflux Disease. Presentations and Approach to Treatment. Gastroesophageal Reflux Disease. Gastroenterology Clinics of North America 1999; 28: 861-873.

15. Gislason T, Janson Ch, Vermeire P et al. Respiratory Symptoms and Nocturnal Gastroesophageal Reflux. A Population-Based Study of Young Adults in Three European Countries. Chest 2002; 121: 158-163.

16. Halstead LA. Role of gastroesophageal reflux in pediatric upper airway disorders. Otolaryngology-Head and Neck Surgery 1999; 120: 208-214.

17. Hanson DG, Jiang JJ. Diagnosis and Management of Chronic Laryngitis Associated with Reflux. Am J Med 2000;108: 112S-119S.

18. Harding SM. Acid reflux and Asthma. Current opinion in pulmonary Medicine 2003; 9: 42-45.

19. Havas TE, Priestley J, Lowinger DSG A Management Strategy for Vocal Process Granulomas. Laryngoscope 1999; 109: 301- 305.

20. Hogan WJ, Shaker R. Supraesophageal Complications of Gastroesophageal Reflux. Disease-a-Month 2000; 46: 195-232.

21. Ing AJ, Ngu MC, Breslin ABX. Chronic persistent cough and gastro-oesophageal reflux. Thorax 1991; 46: 479-483.

22. Irwin RS, Corrao WM, Pratter MR. Chronic persistent cough in adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis 1981; 123: 413-417.

23. Irwin RS, Curley FJ, French CL. Chronic cough: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 1990; 141: 640-647.

24. Irwin RS, French CL, Curley FJ et al. Chronic cough due to gastroesophageal reflux: clinical, diagnostic, and pathogenetic aspects. Chest 1993; 104: 1511-1517.

25. Isolauri J, Luostarinen M, Isolauri E et al. Natural Course of Gastroesophageal Reflux Disease: 17-22 Year Follow-Up of 60 Patients. Amer J Gastroenterol 1997; 92: 37-41.

26. Jirásek V, Procházka V, Dostalík Z et al. Helicid (omeprazol, Léčiva, a.s.) v léčbě refluxní ezofagitidy. Čes Slov Gastroenet 2000; 54: 43-46.

27. Johnston N, Bulmer D, Gill GA et al. Cell Biology of laryngeal epithelial defenses in health and disease: further studies. Ann Otol Rhinol Laryngol 2003; 112: 481-491.

28. Kahrilas PJ. Gastroesophageal reflux disease. JAMA 1996; 276: 983-998.

29. Kastelik JA, Thompson RH, Aziz I et al. Sex-related Differences in Cough Reflex Sensitivity in Patients with Chronic Cough . Am J Respiratory and Critical Care Medicine 2002; 16: 961-964.

30. Kiljander TO, Salomaa ERM, Hietanen EK et al. Gastroesophageal reflux and Bronchial Responsivness: Correlation and the Effect of Fundoplication. Respiration 2002; 69: 434-439.

31. Kolek V. Formy kašle. In: Kolek V. Chronický kašel - příčiny, diagnostika, léčba. Praha: Vltavín 2000: 7-8.

32. Koufman JA, Aviv JE, Casiano RR et al. Laryngopharyngeal reflux: Position statement of the Comittee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2002; 127: 32-35.

33. Locke GR III. What is the prevalence of gastroesophageal reflux disease in a population-based study? In: Giuli R, Galmiche JP, Jamieson Glynn G et al (Eds.). O.E.S.O. - The esophagogastric junction. Paris: John Libbey Eurotext 1998: 493-496.

34. Lukáš K et al. Definice. In: Lukáš K et al. Refluxní choroba jícnu. Karolinum: Praha 2003: 7-8.

35. Lukáš K et al. Diagnóza. In: Lukáš K et al. Refluxní choroba jícnu. Praha: Karolinum 2003: 78-111.

36. Lukáš K et al. Klinický obraz. In: Lukáš K et al. Refluxní choroba jícnu. Praha: Karolinum 2003: 42-56

37. Lukáš K. Současné názory na patofyziologii refluxní choroby jícnu. Čes Slov Gastroent 1995; 49: 27-29.

38. Mansfield LE, Stein MR. Gastroesophageal reflux and asthma: a possible reflex mechanism. Ann Allergy 1978; 41: 224-226.

39. Matuška J. Asthma bronchiale a refluxní nemoc jícnu. Alergie 2001; 3: 234-241.

40. Postma GN. Ambulatory pH monitoring methodology. Ann Otol Rhinol Laryngol 2000; 109 (Suppl 184): 10-14.

41. Postma GN, Belafsky PC, Aviv JE et al. Laryngopharyngeal reflux testing. ENT 2002; 81: 14-18.

42. Richter JE. Typical and atypical presentation of gastroesophageal reflux disease. Gastroenterol Clin A Am 1996; 25: 75-102.

43. Shaker R, Dodds WJ, Hogan WJ et al. Mechanisms of esophago-pharyngeal acid regurgitation. Gastroenterology 1991; 100: A494.

44. Smout AJPM, Akkermans LMA. Gastro-oesophageal reflux disease. In: Smout AJPM, Akkermans LMA. Normal and disturbed motility of the gastrointestinal tract. s.. Petersfield (UK): Wrightson Biomedical Publishing 1992: 67-86

45. Smyrnios NA, Irwin RS, Curley FJ. Chronic cough with history of excessive sputum production: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Chest 1995; 108: 991-997.

46. Sontag SJ. What are the potential mechanisms for esophageal acid-induced bronchoconstrition? In: Giuli R, Galmiche JP, Jamieson Glynn G et al (Eds). O.E.S.O. - The esophagogastric junction. Paris: John Libbey Eurotext 1998: 592-598.

47. Stendal C. Reflux disorders. Pulmonary manifestations of gastroesophageal reflux. In: Stendal C. Pratical guide to gastrointestinal functional testing. Oxford: Blackwell Science Ltd 1998. 64-68.

48. Theodoropoulos DS, Lockey RF, Boyce HW Jr et al. Gastroesophageal reflux and asthma: a review of pathogenesis, diagnosis, and therapy. Allergy 1999; 54: 651-661.

49. Toohill RJ, Kuhn JC. Role of refluxed acid in pathogenesis of laryngeal disorders. Am J Med 1997; 103: 100S-106S.

50. Ulualp SO, Toohill RJ. Laryngopharyngeal reflux: state of the art diagnosis and treatment. Otolaryngol Clin North Am 2000; 33: 785-801.

51. Vadenplas Y, Goyvaerts H, Helven R et al. Gastroesophageal reflux, as measured by 24 hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics 1991; 88: 834-840.

52. Vaezi MF. Gastroesophageal Reflux Disease and the Larynx. J Clin Gastroenterol 2003; 36: 198-203.

53. Williams RBH, Ali GN, Wallace KL et al. Esophagopharyngeal Acid regurgitation: Dual pH Monitoring Criteria for Its Detection and Insights Into Mechanisms. Gastroenterology 1999; 117: 1051-1061.

54. Wo JM, Hunter JG, Waring JP. Dual-channel ambulatory pH monitoring - a useful diagnostic tool? Dig Dis Sci 1997; 42: 2222-2226.

55. Wong RHK, Hanson DG, Waring PJ et al. ENT Manifestations of Gastroesophageal Reflux. Am J Gastroent 2000; 95: S15-S22.

56. Zerbib F, Guisset O, Lamouliatte H et al. Effects of Bronchial Obstruction on Lower Esophageal Sphincter Motility and Gastroesophageal Reflux in Patients with Asthma. Am J Respir Crit Care Med 2002; 166: 1206-1211.