Patients with gastroesophageal reflux disease and respiratory manifestations do not present lung function disorders during cardiopulmonary exercise test

Abstract

Gastroesophageal reflux disease (GERD) has been associated with a variety of pulmonary manifestations, but it is unclear if gastroesophageal reflux causes any abnormality in pulmonary function. Cardiopulmonary exercise test (CPET) is a specialized method that is used to evaluate respiratory function during exercise. The aim of this study was to reveal any abnormality of pulmonary function in patients with GERD and respiratory symptoms. We evaluated 34 patients with GERD (24 men and 10 women, aged 21-63) and extraesophageal respiratory symptoms (wheezing and/or cough) before therapy and after a 12-week treatment with double dose of omeprazole. No patient presented abnormal spirometry. CPET was performed in all the patients at baseline and after completion of the 12-week treatment. CPET parameters including VO(2) rest, VO(2) max, VCO(2) rest, VCO(2) max, O(2)-puls rest, O(2)-puls max, HR (heart rate) rest, HRmax, PETCO(2) rest, PETCO(2) max, and VE/VCO(2) slope were recorded pretreatment and posttreatment. Twenty-four patients (70.6%) had esophagitis (grade A-D), 16 patients had hiatal hernia (47.1%), and 13 patients (38.2%) tested positive for Helicobacter pylori. All of the patients completed the CPET. No one presented shortness of breath or respiratory symptoms. CPET parameters were within normal limits in all of the patients. Twenty-eight patients were reevaluated. No improvement in any CPET parameter posttreatment was observed despite remission of esophageal and extraesophageal respiratory symptoms in all patients. No statistically significant difference was observed pretreatment and posttreatment between the patients older and younger than 40 years, smokers and nonsmokers, Hp(+) and Hp(-) patients, and those with and without hiatal hernia and esophagitis. The patients with GERD and respiratory manifestations and normal spirometry present no pulmonary dysfunction during CPET. No alterations in CPET values posttreatment or differences in CPET values according to age, smoking, Hp status, presence of esophagitis, or hiatal hernia were observed.

Left Atrial Compression and the Mechanism of Exercise Impairment in Patients With a Large Hiatal Hernia

“…Although the effects on respiratory function, diaphragmatic motility, ventilation, and perfusion are intuitively apparent, previous reports quantifying these effects are limited (6 -10). Gastroesophageal reflux, which is common in HH and associated with respiratory symptoms, appears to have no effect on exercise capacity (11).…”

The Effects of Diaphragmatic Breathing and Omeprazole on Respiratory Indices and Diaphragmatic Excursion in Patients with Gastroesophageal Reflux Disease

“…Those who took omeprazole for 2 months showed a 43% decrease and those who took 3 months of use omeprazole showed a 57% reduction in asthma symptoms (20). Also, Giannikoulis et al found no improvement in cardiopulmonary exercise test after 12 weeks of the treatment with a double dose of omeprazole (21). The different results may be due to the long usage and refractory period of omeprazole (22).…”