The Effects of Antireflux Surgery on Asthmatics With Gastroesophageal Reflux

Field, Stephen K.; Gelfand, Gary; McFadden, Sean

doi:10.1378/chest.116.3.766

Cited by 105 publications

(56 citation statements)

References 44 publications

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“…Ruth et al (105) found that fundoplication improved asthma symptoms but did not improve pulmonary function or bronchial reactivity to methacholine. The additional data do not change the findings of the recent critical review on antireflux surgery (82). The effects of both surgical and medical antireflux therapy on asthma show a paradox.…”

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 66%

“…Antireflux surgery improves GER symptoms, asthma symptoms and asthma medication requirements but does not improve pulmonary function (Figure 4) (3,4,6,84-102). Limiting the analysis to the effects of Nissen fundoplication, the current gold standard surgical procedure, did not alter the findings ( Figure 5) (82).…”

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 86%

“…The effects of both surgical and medical antireflux therapy on asthma show a paradox. Antireflux therapy improves asthma symptoms and asthma medication requirements but does not improve pulmonary function (82).…”

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 97%

“…A recent review identified 24 reports, with more than 400 patients, on the effects of antireflux surgery in asthma (82). The two controlled trials demonstrated that antireflux surgery improves asthma symptoms and asthma medication requirements but does not improve pulmonary function (67,83).…”

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 99%

“…Most studies were relatively short, and Meier (77) reported persistent esophagitis even after six weeks of daily therapy with 40 mg of omeprazole. Most studies of the effects of both medical and surgical antireflux therapy contained small numbers of patients, and beta error cannot be excluded as the reason that a positive effect was not demonstrated (82).…”

Section: Alternative Explanations Of the Paradoxmentioning

confidence: 99%

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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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Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 66%

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 86%

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 97%

Section: Effects Of Surgical Antireflux Therapymentioning

confidence: 99%

Section: Alternative Explanations Of the Paradoxmentioning

confidence: 99%

See 3 more Smart Citations