pylori serology for IPF patients vs. controls. Although a small study, the reflex cough questionnaire score-a validated measure of non-acidic airway reflux-was significantly higher for IPF patients, revealing the potential importance of a diagnosis of non-acidic reflux disease for these patients. Recently, more studies have addressed asymptomatic GER and the choice of diagnostic test. A recent prospective study of patients with ILD and IPF reestablished that the sensitivity and specificity of symptoms alone was very low and that esophageal function testing should be used to establish a diagnosis
The disease tends to develop in middle age, especially so in obese individuals, with the valve located toward the bottom of the esophagus weakening. If the acid refluxes only into the esophagus, the sufferer will have heartburn. However, when the acid backs up as far as the throat, the individual will cough and choke.
Experts are not sure why people who have COPD also commonly suffer from GERD. However, studies suggest that changes in the lungs and shortness of breath may have something to do with it. With GERD, a band of muscle called a sphincter that controls the flow of food between the esophagus (eating tube in the throat) and the stomach does not function as well as it should. As a result, the flow of food can back up in the wrong direction, causing heartburn and other symptoms.
Gastroesophageal reflux disease (GERD) is the long-term, regular occurrence of acid reflux. This can cause heartburn and tissue damage, among other symptoms.
In a study by Sweet and colleagues, 67 % of IPF patients referred for lung transplantation had abnormal esophageal reflux, and 65 % of these patients had a hypotensive LES. Furthermore, 50 % of patients with reflux had abnormal esophageal peristalsis [42 ]. The authors note that distal reflux and markers of microaspiration have been associated with early chronic allograft rejection after transplantation, suggesting microaspiration may cause direct lung injury [43 , 44 ]. In addition to verifying a high prevalence of GER in IPF, this study also confirmed the finding that symptoms do not significantly correlate with reflux severity. Bandeira and colleagues also attempted to quantify the prevalence of abnormal acid reflux in IPF patients by use of multiple diagnostic tests [39 ].
In agreement with Tobinâ€™s work, they found that a substantial percentage (80 %) of these patients experience reflux events in the supine position. There was no association between pulmonary function and GER.
It is recommended to test for early lung diffusion and airway obstruction among GERD patients even in the absence of respiratory symptoms in order to avoid further complications. An asymmetrical fibrotic pattern on computed tomography (CT) scans may also be a potential indicator of microaspiration. Symptomatic reflux and GER on objective testing were higher for 32 IPF patients with more than 20 % asymmetrical fibrosis by CT scan, than for those without asymmetrical fibrosis (62.5 vs. 31.3 %).
Indeed, in 1698, Sir John Floyer in his great book, A Treatise on the Asthma (fig. 1), vividly describes what he terms as flatulent asthma . In 1881, Congreve described â€œa dry or nervous asthmaâ€, which is accompanied by flatulence and he observes that dyspepsia is â€œan accompanying evil and perhaps the exciting causeâ€ . However, with the discovery of the cellular and molecular basis of allergic disease and its emphasis on allergens, the entire focus of research has been towards external factors which are inhaled. This extrinsic hypothesis is the current, exclusive, paradigm used to explain respiratory disease. The balance needs redressing.
The diagnosis of GERD only requires distinct reflux symptoms, whereas RE requires mucosal changes in the esophagus, and GER is confirmed by measuring esophageal pH through 24 hour ambulatory pH monitoring [14,16]. Most studies of GERD in COPD have used self-reported questionnaires [4,6,8,9,10,11] though some have measured esophageal pH [7,15].
In a 12-month trial of 100 older patients with GERD, PPI therapy reduced the frequency of AECOPD and common colds compared to usual care.118 Improvement in symptoms of laryngopharyngeal reflux, GERD, and respiratory symptoms in individuals with COPD has been found with a combined approach of H 2 -RA and PPI therapy in some studies.12,79 Although several studies reported on the prescription of antireflux medication in COPD, they did not report on the impact of therapy on lung function.12,56,57 Therefore, the effects of pharmacological management of GERD on lung function, the co-occurrence of respiratory and GERD symptoms, and the use of respiratory medications remain to be clarified. The persistence of symptoms despite antireflux therapy suggests that acid reflux may not always be the primary cause;119 this pharmacological approach does not target nonacid or weakly acidic reflux. Surgical management, with a Nissen Fundoplication, has been successfully applied to patients with severe lung disease, including COPD, awaiting transplantation,120-122 with reductions in symptoms of GERD as well as of lung disease123 and improved lung function in the small group of individuals with COPD.120-122 Antireflux surgery is not widely used in COPD but should be considered when medical management fails, especially when GERD remains severe in individuals with COPD at risk of respiratory deterioration.