Gastroesophageal reflux as a cause of chronic cough, severe asthma, and migratory pulmonary infiltrates

Abstract

Gastroesophageal reflux (GER), asthma-type cough and upper airway disease are the most common causes of chronic cough syndrome. We present a case in which impedance–pH monitoring indicated severe mixed acid–nonacid esophageal reflux reaching the upper third of the esophagus in 75% of nonacid events. GER and the associated aspiration episodes were shown to be the cause of severe asthma attacks and migratory pulmonary infiltrates. GER was caused by a sleeve gastrectomy, which seriously disabled the mechanisms preventing reflux from reaching the airways. Respiratory symptoms improved notably after abdominal surgery to correct the GER, suggesting a close causal relationship between GER and all the symptoms, including asthma. However, this issue remains unresolved in the literature.

Natural history of Mycobacterium fortuitum pulmonary infection presenting with migratory infiltrates: a case report with microbiological analysis

“…Various pulmonary diseases such as cryptogenic organizing pneumonia, chronic eosinophilic pneumonia, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, lymphoproliferative disorder, vasculitis, and aspiration pneumonitis can cause migratory infiltrates [ 17 – 20 ]. Furthermore, gastroesophageal reflux can introduce pulmonary infiltrates, leading to aspiration pneumonitis [ 21 ]. In view of NTM infection, one case on Mycobacterium abscessus complex pulmonary infection has also shown migratory infiltrates [ 22 ].…”

Identification and treatment of T2-low asthma in the era of biologics

“…The main clinical and pathophysiological characteristics that can help distinguish T2-low from T2-high asthma are shown in Table 1, while possible pathogenetic pathways; current drug targets and those in the development pipeline are shown in Figure 1. [62] and neurogenic inflammation in the lung [63]. Erythromycin has been shown to promote gastric and small bowel motility [64], increase lower oesophagal sphincter pressure [65] and affect gallbladder function [66].…”

“…Macrolides exhibit their beneficial effects in NA with three mechanisms: 1) they exert antibacterial [ 56 ] and antiviral actions [ 57 ]; 2) they demonstrate immunomodulatory effects and anti-inflammatory activity through inhibition of transcription factors such as NFκB, reduction of activation and migration of neutrophils [ 58 ], revitalisation of corticosteroid sensitivity by inhibiting the phosphatidylinositol 3-kinase (PI3K) pathway and restoring histone deacetylase-2 [ 59 ] and by attenuating TNF-α and IL-17 immune responses [ 58 ]; and 3) they display prokinetic properties, thus diminishing the pernicious consequences of reflux and aspiration events [ 60 ]. Although not explicitly highlighted, macrolides reduce the sequence of reflux effects that include micro and macro aspiration of gastric contents, bronchoconstriction mediated by vagal reflexes [ 61 ] and neurogenic inflammation in the lung [ 62 ]. Erythromycin has been shown to promote gastric and small-bowel motility [ 63 ], increase lower oesophagal sphincter pressure [ 64 ] and affect gallbladder function [ 65 ].…”

Outcomes variation in weight and resolution of obesity co-morbidities between five bariatric operations

“…SG was the only operation that worsened asthma, a finding that has been described by other sources, citing increasing GERD symptoms as the likely etiology. 23 Outcomes in resolution of diabetes did not demonstrate any definitive advantage between malabsorptive and restrictive procedures. The connection between obesity and type 2 diabetes has been well established and reduction in excess body mass predominates as the most effective treatment.…”