Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis

Abstract

The clinical presentation of noncystic fibrosis bronchiectasis may be complicated by concomitant conditions, including gastro-oesophageal reflux (GOR). Increased acidic GOR is principally caused by gastro-oesophageal junction incompetence and may arise from lower oesophageal sphincter hypotension, including transient relaxations, hiatus hernia, and oesophageal dysmotility. Specific pathophysiological features which are characteristic of respiratory diseases including coughing may further increase the risk of GOR in bronchiectasis. Reflux may impact on lung disease severity by two mechanisms, reflex bronchoconstriction and pulmonary microaspiration. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence of 26 to 75%. The cause and effect relationship has not been established, but preliminary reports suggest that GOR may influence the severity of bronchiectasis. Further studies examining the implications of GOR in this condition, including its effect across the disease spectrum using a combination of diagnostic tools, will clarify the clinical significance of this comorbidity.

Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

“…There is a high prevalence of reflux in asthmatics and chronic cough, which may be induced through different mechanisms including microaspiration and both local and central reflexes [18]. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence from 26% to 75%, and aspiration of gastric contents in the respiratory tree is not rare in patients with GER [19,20]. In a group of patients with advanced lung disease including bronchiectasis manometry showed that 57% of patients had LES hypotonia and 14% had UES hypotonia [21].…”

British Thoracic Society Guideline for bronchiectasis in adults

“…This finding was not confined to those with severe lung disease, and the detection of pepsin within sputum in this study did not correlate with the finding of GORD. 314 …”

“…314 Some studies of H. pylori serology have shown higher levels in bronchiectasis patients compared with control populations. In one study of 100 patients with bronchiectasis measuring specific IgG to H. pylori , seroprevalence was 76% compared with 54.3% of controls.…”

A qualitative synthesis of gastro-oesophageal reflux in bronchiectasis: Current understanding and future risk

“…(17) Symptom assessment through validated questionnaires, which ideally incorporate both oesophageal and extra-oesophageal symptoms so as not to limit their applicability in the setting of silent reflux, may be needed. (18) In the presence of typical reflux symptoms, an empirical trial of acid suppression therapy is often undertaken, with resolution of symptoms considered clinically indicative of GORD. (15) In those with persisting symptoms despite therapy, objective tools such as an oesophago-gastro-duodenoscopy may be used to identify secondary complications of mucosal injury and oesophagitis.…”