Review article: respiratory manifestations of gastro‐oesophageal reflux disease

• Published in: Alimentary pharmacology & therapeutics Vol. 27; no. 6; pp. 449 - 464
• Main Authors: GALMICHE, J. P., ZERBIB, F., BRULEY DES VARANNES, S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 15.03.2008; Blackwell
• Subjects: Anti-Asthmatic Agents; Asthma - complications; Asthma - physiopathology; Asthma - therapy; Biological and medical sciences; Chronic Disease; Digestive system; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - therapy; Humans; Medical sciences; Other diseases. Semiology; Pharmacology. Drug treatments; Proton Pump Inhibitors; Respiration Disorders - complications; Respiration Disorders - physiopathology; Respiration Disorders - therapy; Gastroesophageal reflux; Digestive diseases; Review; Respiratory system; Bibliographic review; Esophageal disease
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2008.03611.x

Summary Background  Respiratory manifestations represent one of the most prevalent and difficult‐to‐manage extra‐oesophageal syndromes of gastro‐oesophageal reflux disease. Aims  To review the epidemiology, pathophysiological mechanisms and therapeutic outcomes of reflux‐related respiratory disorders. Methods  Search of the literature published in English using PubMed database. Results  There is a discrepancy between the high prevalence of reflux in asthmatics and the limited efficacy of antireflux therapies. Asthma per se may cause reflux. Patients with difficult‐to‐treat asthma and/or nocturnal symptoms should be screened for reflux. Reflux can induce chronic cough through different mechanisms including micro‐aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta‐analysis found no significant difference between placebo and proton pump inhibitors in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH‐impedance monitoring. Attention has been drawn to obstructive sleep apnoea syndrome. Conclusions  The role of gastro‐oesophageal reflux disease in the pathogenesis of miscellaneous respiratory disorders has been discussed for decades and established in asthma and cough. However, no major therapeutic advances have been reported recently. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH‐impedance monitoring.