Allergic rhinitis is a risk factor of gastro-esophageal reflux disease regardless of the presence of asthma

Abstract

Gastroesophageal reflux disease (GERD) can cause several upper airway symptoms and alter the physiology of nasopharyngeal mucosa, while upper airway diseases in turn might also exacerbate GERD symptoms. For a long time, asthma was considered a risk factor of GERD in the literature. Asthma and allergic rhinitis (AR) are usually identified as united airway disease according to similar epidemiology and pathophysiology; however, the association between AR and GERD is less elucidated. We aimed to evaluate whether AR would increase the development of GERD. Patients diagnosed as AR were identified from the National Health Insurance Research Database between January 1, 2000 and December 31, 2005 without prior history of gastroesophageal reflux disease. The outcome of interest was new-onset GERD. Cox regression models were applied to calculate the hazard ratio (HR) of GERD. We analyzed the data of 193,810 AR patients aged 18 years or older and being free of AR at baseline. The AR cohort (n = 96,905) had a significantly increased risk of GERD over a non-AR cohort (n = 96905) (adjusted HR (aHR) 1.94; 95% CI = 1.88–1.99, p < 0.001). AR may have stronger correlation with GERD than does asthma, although asthma might increase GERD risk by means of certain pathways shared with AR.

Allergic rhinitis, asthma and gastro-esophageal reflux disease: a cross-sectional study on their reciprocal relations

“…We found in our study that LPR and AR occurred simultaneously more frequently as having LPR increased the incidence for AR by more than two folds which is similar to other studies [17,18]. Having asthma increased the correlation, but the correlation persisted even when excluding asthma which concurs with another study [18]. We also found that subjects with asthma had higher LPR and AR symptom scores which are similar to the study [18].…”

“…A causal link between GORD and AR was not established and only a few studies indicated a correlation [42]. We found in our study that LPR and AR occurred simultaneously more frequently as having LPR increased the incidence for AR by more than two folds which is similar to other studies [17,18]. Having asthma increased the correlation, but the correlation persisted even when excluding asthma which concurs with another study [18].…”

“…Having asthma increased the correlation, but the correlation persisted even when excluding asthma which concurs with another study [18]. We also found that subjects with asthma had higher LPR and AR symptom scores which are similar to the study [18]. Mast cells release histamine as a result of GORD which might promote lower-oesophageal dysfunction [43].…”

“…GORD in addition to Rhinitis in general are among the main causes of chronic cough, and their role has been discussed in several studies; increased reoccurrence of the cough with reflux symptom has also been reported in more than a few patients with GORD and in those with rhinitis who do not have symptoms of GORD, indicating that other factors contribute to the development of chronic cough. In addition, the coexistence of GORD and chronic rhinosinusitis (CRS) were reported by multiple studies [17,18,41,42,45,46]. One theory explaining this phenomena is that Helicobacter pylori, which is usually found in the gastric mucosa and promotes heartburning, can exist in the sinonasal cavity [47].…”

“…AR has a wide variety of symptoms including sneezing, a sore throat, globus pharyngeus, rhinorrhoea and congestion, and postnasal drip [15,16]. As AR and LPR have many symptoms in common resulting from irritation to the aerodigestive tract, they may have a correlation as suggested in many studies regardless of having asthma [17,18]. In this study we used a validated reflux symptom index (RSI) in Arabic [5,[19][20][21][22] to assess LPR and an Arabic version of the score for allergic rhinitis (SFAR) [23,24] to assess AR in Syria and to find if such a correlation exists.…”