Chronic Obstructive Pulmonary Disease Exacerbations Are Influenced by Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is associated with different pulmonary diseases, including chronic obstructive pulmonary disease (COPD). Whether GERD is contributory to COPD severity remains unclear. This study aims to evaluate the contribution of GERD to the clinical manifestation of COPD based on ventilatory parameters and yearly clinical exacerbations. We studied 48 patients (56% females, age 66 years) with COPD. All patients underwent high-resolution manometry and esophageal pH monitoring. The patients were separated into two groups according to the presence of GERD. GERD was present in 21 (44%) patients. GERD + and GERD – groups did not differ in regard to gender, age, and body mass index. Pulmonary parameters were not different in the absence or presence of GERD. The number of yearly exacerbations was higher in patients GERD1. The severity of GERD (as measured by DeMeester score) correlated with the number of exacerbations. Our results show the following: 1) GERD does not influence pulmonary parameters and 2) GERD is associated with a higher number of annual clinical exacerbations. We believe GERD must be objectively tested in patients with COPD because the prevalence of GERD in these patients is underestimated when only symptoms are considered. GERD treatment might decrease the frequency of episodes of exacerbation.

A systematic review with meta-analysis of gastroesophageal reflux disease and exacerbations of chronic obstructive pulmonary disease

“…3) than COPD patients without GERD, however there was observable publication bias (Additional file 1: Figure S1) and statistical heterogeneity. Of note, the diagnostic methods for GERD varied across studies, but only one study relied on objective methods [16], 24-h pH monitoring, in this study, GERD patients exhibited increased the frequency of exacerbation (WMD: 0.58 times per year; 95% CI: 0.03 to 1.13; P = 0.03; data not shown). Figure 4 shows a pooled analysis of the relationship between GERD patients and the frequency of COPD exacerbation in Asian areas, COPD patients with GERD showed a higher frequency of exacerbations (WMD: 0.618 times per year; 95% CI: 0.40 to 0.82; P = 0.28; I 2 = 22%; Fig.…”

“…Of the 17 articles selected for detailed evaluation, 7 were excluded because GERD+ patients could not be isolated (1), the comparison is not GERD+ vs GERD-in COPD patients (2), they didn't involve the COPD exacerbation (3), exposure is not GERD (1). Ultimately, 10 articles were included in the meta-analysis [8,9,[16][17][18][19][20][21][22][23], selection process was shown in Fig. 1.…”

“…Of these, three studies were conducted in America, one in Europe and six in Asia. Records from Japan [8,9,20,21], Taiwan [17], Iran [22] were defined as Asian studies, while those from Europe [18] and America [16,19,23] were defined as Western studies. Sample size ranged from 48 to 5912 patients, and the meta-analysis consisted with a total sample size of13245 including 9 cohort studies and 2 cross-sectional studies.…”

“…Sample size ranged from 48 to 5912 patients, and the meta-analysis consisted with a total sample size of13245 including 9 cohort studies and 2 cross-sectional studies. Only one article used 24-h pH monitoring to diagnose GERD [16].…”

Gastroesophageal Reflux Disease and Idiopathic Lung Fibrosis. From Heartburn to Lung Transplant, and Beyond

“…3 Many pulmonary diseases have been linked to GERD, from asthma to chronic obstructive pulmonary disease (COPD). 4,5 There is evidence that idiopathic pulmonary fibrosis (IPF) may also be linked to GERD. 6…”