Esophageal Reflux as a Trigger in Asthma

Overholt, Richard H.; Voorhees, Robert J.

doi:10.1378/chest.49.5.464

Cited by 88 publications

(28 citation statements)

References 2 publications

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“…Such patients are at risk for aspiration of fluid into the lung along with eventual respiratory symptoms, including recurrent pulmonary infections or asthma [20][21][22][23][24][25][26]. Such regurgitation of esophageal (and/or gastric) contents into the pharynx could result in inflammation with subsequent weakening of the wall or scarring.…”

Section: Other Radiographic Changes In the Pharynx Resulting From Esomentioning

confidence: 99%

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Pharyngoesophageal interrelationships: Observations and working concepts

Jones

Ravich

Donner

et al. 1985

Gastrointest Radiol

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Simultaneous disorders of the pharynx and esophagus are so frequent that the complete swallowing chain should be examined in all patients with dysphagia. Data are presented to support the concept that such simultaneous disorders represent related phenomena; the mechanism involves changes in cricopharyngeal function seen radiographically as cricopharyngeal prominence. If neurologic disease has been excluded, cricopharyngeal prominence may be the clue to esophageal disease. When cricopharyngeal prominence is found during dynamic imaging of the pharynx, intensive examination of the esophagus and a search for signs of compensation or decompensation in the pharynx should be undertaken.

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Section: Other Radiographic Changes In the Pharynx Resulting From Esomentioning

confidence: 99%

“…Gastroesophageal reflux with regurgitation of esophageal contents above the pharyngoesophageal segment has been shown to be responsible for respiratory symptoms in both children and adults [20][21][22][23][24][25][26]. Response to antireflux therapy in patients with asthma and documented reflux can be dramatic.…”

Section: Clinical Observationsmentioning

confidence: 99%

Pharyngoesophageal interrelationships: Observations and working concepts

Jones

Ravich

Donner

et al. 1985

Gastrointest Radiol

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“…This also may be important for respiratory control during vomiting. In pathological states, these reflexes may be exaggerated and, thus, may play a role in reflux-induced asthma and noncardiac chest pain (Kennedy, 1962;Overholt and Voorhees, 1966;Klotz and Moeller, 1971;Orringer, 1979;Castell, 1992;Cunningham et al, 1992;Davis, 1992;Harding et al, 1995).…”

Section: Functional Considerationsmentioning

confidence: 99%

Local differences in vagal afferent innervation of the rat esophagus are reflected by neurochemical differences at the level of the sensory ganglia and by different brainstem projections

Wank

Neuhuber

2001

J of Comparative Neurology

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The objective of the present study was to characterize further the vagal afferent fibers in the rat esophagus, particularly those in its uppermost part, their cell bodies in vagal sensory ganglia, and their central projections. We applied immunohistochemistry for calretinin, calbindin, and calcitonin gene-related peptide (CGRP); retrograde tracing with FluoroGold; and transganglionic tracing with wheat germ agglutinin-horseradish peroxidase in combination with neurectomies. Vagal terminal structures in the muscularis propria of the whole esophagus consisted of calretinin-immunoreactive intraganglionic laminar endings that were linked to cervical vagal and recurrent laryngeal nerve pathways. The mucosa of the uppermost esophagus was innervated by a very dense net of longitudinally arranged, calretinin-positive fibers that were depleted by section of the superior laryngeal nerve. Distal to this area, the mucosa was virtually devoid of calretinin-immunoreactive vagal afferents. Calretinin-positive mucosal fibers in the upper cervical esophagus were classified into four types. One type, the finger-like endings, was sometimes immunoreactive also for CGRP. About one-third of cell bodies in vagal sensory ganglia retrogradely labeled from the upper cervical esophagus expressed CGRP, whereas two-thirds coexpressed calretinin and calbindin but not CGRP. In addition to the central subnucleus of the nucleus of the solitary tract, vagal afferents from the upper cervical esophagus also projected heavily to the interstitial subnucleus. This additional projection was attributed to mucosal afferents traveling through the superior laryngeal nerve. The present study provides a possible morphological basis for bronchopulmonary and aversive reflexes elicited upon stimulation of the esophagus.

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“…Since the 1960s, antireflux surgery has been reported to be beneficial in asthma patients with GER (3,4). A recent review identified 24 reports, with more than 400 patients, on the effects of antireflux surgery in asthma (82).…”

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 99%

Gastroesophageal Reflux and Asthma: Can the Paradox Be Explained?

Field¹

2000

Canadian Respiratory Journal

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BACKGROUND AND OBJECTIVE:The reported effects of asthma on gastroesophageal reflux (GER), effects of GER on asthma and the effects of antireflux therapy on asthma are conflicting. The purpose of this paper is to review the evidence for a relationship between the two conditions.DESIGN:A search of the MEDLINE 1966 to 1999 database, combining the terms GER and asthma, was used to identify studies of the effects of acid perfusion of the esophagus, the physiological equivalent of GER and the effects of both medical and surgical antireflux therapy on asthma. Bibliographies of the identified papers were also reviewed.MAIN RESULTS:The collected evidence suggests that GER causes asthma symptoms but has minimal effects on pulmonary function. Both medical and surgical antireflux therapy can improve asthma symptoms and asthma medication requirements without improving pulmonary function. The paradox of GER causing symptoms without affecting pulmonary function may be because of the retrosternal discomfort that accompanies GER increases minute ventilation and respiratory sensation.CONCLUSIONS:Despite an extensive body of literature, many questions remain about the relationship between GER and asthma. A review of the data suggests a strong association between the two conditions, and that GER worsens asthma symptoms without affecting pulmonary function. Asymptomatic GER does not worsen asthma. Antireflux therapy may have a role in asthma patients with symptomatic GER, possibly being most beneficial for those with reflux-associated respiratory symptoms. Unfortunately, many studies contain flaws such as a lack of controls and small sample sizes. Further properly designed controlled trials, including ones that measure the effects of GER and antireflux therapy on quality of life, are needed to understand better the role of GER in asthma.

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Esophageal Reflux as a Trigger in Asthma

Cited by 88 publications

References 2 publications

Pharyngoesophageal interrelationships: Observations and working concepts

Pharyngoesophageal interrelationships: Observations and working concepts

Local differences in vagal afferent innervation of the rat esophagus are reflected by neurochemical differences at the level of the sensory ganglia and by different brainstem projections

Gastroesophageal Reflux and Asthma: Can the Paradox Be Explained?

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