Association between chronic obstructive pulmonary disease and gastroesophageal reflux disease: a national cross-sectional cohort study

Abstract

BackgroundGastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough and a potential risk factor for exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors of GERD in patients with COPD and association between GERD and COPD exacerbation.MethodsData were collected from the National Health Insurance Database of Korea. The subjects were 40 years old and older, who had COPD as primary or secondary diagnosis codes and utilized health care resource to receive prescriptions of COPD medication at least twice in 2009. Univariate logistic regression was performed to understand the relationship between COPD and GERD, and multiple logistic regression analysis was performed with adjustment for several confounding factors.ResultsThe prevalence of GERD in COPD patients was 28% (39,987/141,057). Old age, female gender, medical aid insurance type, hospitalization, and emergency room (ER) visit were associated with GERD. Most of COPD medications except inhaled muscarinic antagonists were associated with GERD. The logistic regression analysis showed that the presence of GERD was associated with increased risk of hospitalization (OR 1.54, CI 1.50 to 1.58, p<0.001) and frequent ER visits (OR 1.55, CI 1.48 to 1.62, p<0.001).ConclusionsThe prevalence of GERD in patients with COPD was high. Old age, female gender, medical aid insurance type, and many COPD medications except inhaled muscarinic antagonists were associated with GERD. The presence of GERD was associated with COPD exacerbation.

Idiopathic Pulmonary Fibrosis: Novel Concepts of Proton Pump Inhibitors as Antifibrotic Drugs

“…Gastroesophageal reflux (GER) and GER disease (GERD) appear to disproportionately affect patients with idiopathic pulmonary fibrosis (IPF; 87-94%) (2, 3) compared with the general population (10-19%) (4) or patients with other advanced lung diseases, including cystic fibrosis (35-81%) (5), asthma (59-68%) (3,6), chronic obstructive pulmonary disease (19-28%) (7,8), and bronchiolitis obliterans syndrome (9). Although the exact mechanism for the higher GER prevalence in IPF is not clear, the relationship between GER and pulmonary fibrosis has been recognized for the past 40 years (10).…”

Defining COPD-Related Comorbidities, 2004-2014

“…Almost all COPD outcomes are impacted by coexistent GERD, including poorer HR-QOL and more severe symptoms. 83,84 The risk of frequent exacerbations with coexistent GERD has been reported with an OR of 1.7(95% CI 1.4-2.0) 85 in a large cohort study, to an OR of 1.5(95% CI 1.5-1.6) in crosssectional analysis of administrative databases 79 to a RR of 1.9(95% CI 1.3-2.8) to 2.2 in smaller cohorts. 76,86 Observational data has shown better HR-QOL in those with treated GERD, 83 and only one clinical trial has addressed the question of treating COPD with proton-pump inhibitor medications and the risk of exacerbations 87 ; their results (77% reduction of exacerbations) have not been replicated or extended in subsequent analysis or trials; thus, specific therapeutic recommendations are not available.…”

“…Although researchers have used many different definitions of gastroesophageal reflux disease (GERD), including validated questionnaires, 75-77 esophageal pHmonitors, 78 and administrative medical claims data, 79 there is a consistently higher prevalence of the disease among those with COPD than in the general population. The findings are also consistent across different designs and populations, including cross-sectional studies of COPD patients reporting prevalence between 16% and 62%, 80 and population-based representative surveys describing a prevalence of 28%.…”

“…The findings are also consistent across different designs and populations, including cross-sectional studies of COPD patients reporting prevalence between 16% and 62%, 80 and population-based representative surveys describing a prevalence of 28%. 79 There is, however, limited evidence concerning the direction of the relation. One study of the United Kingdom General Practice Research Database detected a low frequency of receiving a new diagnosis of COPD after a diagnosis of GERD was established, but a higher frequency of incident GERD diagnosis among those with established COPD.…”

Bronchial reacutization and gastroesophageal reflux: is there a potential clinical correlation?

“…Even if heartburn and regurgitation represent the most common clinical manifestation, sometimes GERD is asymptomatic and causes extraesophageal symptoms such as asthma, dysphonia, sore or burning throat, excessive throat clearing, chronic cough, globes pharyngeus, apnea, laryngospasm, laryngitis, dysphagia, and postnasal drip (3). Nevertheless, GERD is a risk factor for bronchial exacerbations in patients with chronic obstructive pulmonary disease (COPD) (4). LPR differs from GERD in many aspects, such as symptoms, treatment modalities, and pathophysiology.…”