Focus on the Connections Between Gastroesophageal Reflux Disease and COPD Exacerbations
In recent years, evidence has emerged of a higher prevalence of gastroesophageal reflux disease (GERD) in patients with chronic obstructive pulmonary disease (COPD). GERD symptoms are more common in them, especially in patients with severe COPD and frequent exacerbations. Why is this, and what direct links can be traced between the two diseases?
Introduction
Chronic obstructive pulmonary disease is a relatively common lung disease characterized by long-term inflammation in the airways. The condition of patients is complicated by acute disease exacerbations, during which respiratory symptoms worsen further. On average, COPD patients experience 2 severe exacerbations per year.
Gastroesophageal reflux disease is one of the most common diseases worldwide. It is caused by the backflow of stomach acids into the esophagus, leading to damage to the esophageal lining. Clinical symptoms of GERD include chest burning and regurgitation of food.
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GERD is associated with coughing, reduced lung function, and increased bronchial reactivity. Conversely, frequent coughing and the use of β2-agonists trigger the reflux of acidic fluids into the esophagus. This creates a vicious circle.
Additionally, both the bronchial tree and the esophagus are innervated by the vagus nerve, so the stimulation of the esophagus by refluxed fluid can reflexively cause bronchoconstriction and trigger a coughing reflex. Exacerbations of COPD in patients with GERD can also be caused by the inhalation of refluxed fluid into the airways.
It is therefore not surprising that GERD is considered a risk factor for exacerbations in COPD patients and is associated with significantly higher rates of COPD exacerbations, increased risk of ICU admission, and the need for mechanical ventilation during exacerbations.
Findings from Meta-Analysis
Huang et al. decided to conduct a meta-analysis of studies investigating the relationship between GERD and COPD. In the preparatory phase, they reviewed 2807 papers, of which 17 were selected for detailed evaluation and 10 were ultimately included in the meta-analysis. The results showed that GERD increases the risk of exacerbation in COPD patients, and those with both COPD and GERD have more exacerbations annually.
An important factor that can affect the conclusions of such studies is pharmacotherapy. In some studies, it appeared that treatment of GERD with proton pump inhibitors (PPIs) led to a decrease in the frequency of exacerbations, but in other studies, the effect was the opposite.
Conclusion
Available data suggest that GERD is associated with an increased risk of COPD exacerbation. Therefore, physicians should consider whether to devote more time to the prevention and treatment of GERD in COPD patients.
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Source: Huang C., Liu Y., Shi G. A systematic review with meta-analysis of gastroesophageal reflux disease and exacerbations of chronic obstructive pulmonary disease. BMC Pulm Med 2020; 20 (1): 2, doi: 10.1186/s12890-019-1027-z.
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