Chronic Respiratory Symptoms and Occult Gastroesophageal Reflux

Abstract

Seventy-seven patients with a primary complaint of persistent cough, wheezing, and/or recurrent pneumonia were evaluated for the presence of occult gastroesophageal reflux disease. Fifty-four patients (70%) had increased esophageal acid exposure on 24-hour pH monitoring of the distal esophagus. In 28% of these patients the respiratory symptoms were thought to be due to aspiration because they occurred during or within 3 minutes after a reflux episode. In the other patients, the respiratory symptoms were either induced by or were unrelated to reflux episodes. The number of respiratory symptoms reported by the patients with increased esophageal acid exposure was directly related to the presence of a nonspecific esophageal motility abnormality (p less than 0.05). This suggested that a motility disorder contributes to aspiration by promoting the aboral flow of refluxed gastric juice. Seventeen patients with increased esophageal acid exposure had an antireflux operation to relieve their respiratory complaints. Patients whose respiratory symptoms induced reflux episodes were not helped by the procedure. Of the other patients, symptoms were abolished by the procedure only in those with normal esophageal motility. It is concluded that the majority of patients suffering from chronic unexplained respiratory symptoms have occult gastroesophageal reflux disease, but only a minority of them are helped by surgery. Carefully performed esophageal function studies are needed to select those patients who will benefit from a surgical antireflux procedure.

Esophageal motility, vagal function and gastroesophageal reflux in a cohort of adult asthmatics

“…Gustafsson et al reported pathological reflux in 50% of asthmatic children in the proximal esophagus and in 16% in the proximal esophagus [29]. DeMeester et al reported that 50% of patients with chronic respiratory symptoms with proximal reflux had esophageal dysmotility [30]. …”

Clinical and Laboratory Characteristics and Surgical Alternatives in Patients with Postoperative Recurrent Reflux Esophagitis

“…The severity o f these symtoms was graded into 4 categories, absent, mild, moderate or severe, according to the crite ria of De Mecster et al [8].…”

Necessity for Surgery in Children with Gastrooesophageal Reflux and Supraoesophageal Symptoms

“…However, recent reviews analysing the data in the literature on the outcome of patients with asthma undergoing anti-reflux surgery highlighted that this surgical approach, improving symptoms and decreasing the need for medications, has a great impact on the patients quality of life. These studies showed an improvement of reflux symptoms, asthma symptoms and pulmonary function in 90 %, 79%, and 27% of operated patients respectively, and a postoperative reduction of medication in 88% (7,22). Many other papers evaluated the incidence of reflux and supraoesophageal symptoms and many doubts are still evident about the need of surgery in this paediatric population (1, 4, 8,11 ± 18, 21, 25, 26).…”