Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review

Abstract

The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies.

Gastro-oesophageal reflux disease increases healthcare use and medical costs in patients with bronchiectasis: a Korean nationwide population-based study

“…Patients with bronchiectasis often have hyperinflated lungs with the descent diaphragm that predisposes the patient to reflux by lowering the resting pressure of the lower oesophageal sphincter. 23 In addition, chronic respiratory symptoms, such as cough and sputum production, can lead to a recurrent sudden increase in intra-abdominal pressure, predisposing reflux. 23 Also, refluxate, whether acidic, nonacidic, or gaseous mistic, 24 can be proinflammatory and cause lung damage, aggravating the bronchiectasis.…”

“… 23 In addition, chronic respiratory symptoms, such as cough and sputum production, can lead to a recurrent sudden increase in intra-abdominal pressure, predisposing reflux. 23 Also, refluxate, whether acidic, nonacidic, or gaseous mistic, 24 can be proinflammatory and cause lung damage, aggravating the bronchiectasis. 23 This will cause a vicious cycle of worsened GORD and bronchiectasis.…”

“… 23 Also, refluxate, whether acidic, nonacidic, or gaseous mistic, 24 can be proinflammatory and cause lung damage, aggravating the bronchiectasis. 23 This will cause a vicious cycle of worsened GORD and bronchiectasis. Our study results are meaningful in terms of providing evidence supporting the theoretical link between bronchiectasis and GORD in increasing healthcare costs.…”

ROSE: radiology, obstruction, symptoms and exposure – a Delphi consensus definition of the association of COPD and bronchiectasis by the EMBARC Airways Working Group

“…Additionally, risk factors are different: the exposure to smoke or other irritants is deemed necessary to confirm diagnosis of COPD, while in [bronchiectasis] BE they are less clear and extremely heterogeneous depending on the patient's age and comorbidities. Some specific conditions, such as primary immunodeficiencies [ 9 ], gastro-oesophageal reflux [ 10 ] or lung tuberculous or non-tuberculous mycobacteria infections [ 11 ], have been described as risk factors for developing bronchiectasis. Additionally, severe chronic asthma [ 12 ] or COPD [ 13 ] are also considered risk factors for developing secondary bronchiectasis.…”

Associations Between Asthma/Asthma Exacerbation and Previous Proton-Pump Inhibitor use: A Nested Case-Control Study using a National Health Screening Cohort

“…A signi cant association between re ux disease and exacerbations in asthmatic patients has been observed (odds ratio [OR] = 4.9 95% Con dence Interval [CI] = 1.4-17.8) [3,4]. Indeed, several randomized clinical trials (RCTs) have been performed to assess whether proton-pump inhibitors (PPIs) can improve asthma-related outcomes; however, there are some mixed ndings [5]. Patients with asthma who had a diagnosis of GERD showed improvement in peak expiratory ow rate and asthma-related quality of life scores but no signi cant bene t for asthma symptom scores and lung function [6][7][8].…”