High Prevalence of Gastroesophageal Reflux Disease with Minimal Mucosal Change in Asthmatic Patients

Abstract

It is known that the prevalence of gastroesophageal reflux disease (GERD) in asthmatic patients is high. Although an endoscopic diagnosis of GERD based on the established Los Angeles (LA) classification requires the detection of erosive mucosal breaks, there are patients with GERD who have prominent erythema of the esophageal membrane without erosive mucosal breaks. Non-erosive mucosal change denotes the minimal change of the discoloring type of reflux esophagitis. This study was undertaken to determine the prevalence of GERD in asthmatic patients using the LA classification with the inclusion of minimal change, compared to the prevalence determined using the established LA classification without minimal change. The presence of GERD in asthmatic patients (n = 78), non-asthmatic disease control patients (n = 56), and healthy subjects (n = 150) was evaluated by endoscopic examination. The frequency of GERD in asthmatic patients based on the LA classification with minimal change was higher (54/78, 69.2%) than in asthmatic patients based on the LA classification without minimal change (37/78, 47.4%) ( p < 0.05). The prevalence of GERD in asthmatic patients (69.2%) was higher than that in disease control patients (17/56, 30.4%) and healthy subjects (27/150, 18.0%) based on the LA classification with minimum change. These data indicate that asthmatic patients have a high frequency of GERD. In addition, without the inclusion of minimum change to the diagnosis of GERD, the prevalence of GERD appears to be underestimated in asthmatic patients. Therefore, physicians should carefully observe asthmatic patients with minimal change on endoscopy.

Proton Pump Inhibitor Improves Breath Marker in Moderate Asthma with Gastroesophageal Reflux Disease

“…Among the 36 asthma patients, 26 agreed to participate in a randomized study of PPI therapy. The diagnosis and severity of moderate asthma were established by using the Global Initiative for Asthma report [23], as described previously [16, 20]. Healthy control subjects were all volunteers.…”

“…Recently, we reported a high prevalence of GERD in asthma patients evaluated by endoscopic examination using the Los Angeles classification with nonerosive minimum mucosal esophageal change and an established questionnaire for the diagnosis of reflux disease (QUEST) [16, 17]. Possible explanations for the relationship between GERD and asthma include direct microaspiration of refluxed acid into the airways or without aspiration of vagal reflux mechanisms of endogenous inflammation due to acid regurgitation to the esophagus [18, 19].…”

Epidemiology and clinical characteristics of GERD in the Japanese population

“…Vagally mediated reflex and microaspiration worsens asthma, while autonomic nerve disturbance and the use of bronchodilators affect GERD. Ten papers [43,[140][141][142][143][144][145][146][147][148] identified an association between GERD and bronchial asthma, and most studies focused on the prevalence of GERD in asthmatics. Although the diagnostic criteria for GERD were different among these studies, the prevalence of GERD in asthmatics was high, ranging from 22.1 to 75.6% (Table 9).…”

Erosive Esophagitis Worsens Reflux Signs and Symptoms in Asthma Patients Without Affecting Pulmonary Function Tests

“…Using gastroesophageal endoscopy, gastroesophageal reflux has been classified into two categories: erosive esophagitis (EO) and non-erosive esophagitis (NEO) (9,10). EO has been reported to occur in 20-40% of patients with gastroesophageal reflux and in 20-47% of patients with asthma (4,6,9,11,12).…”