The Effects of Acid Perfusion of the Esophagus on  Ventilation and Respiratory Sensation

Field, Stephen K.; Evans, John A.; Price, Lorne M.

doi:10.1164/ajrccm.157.4.9707094

Cited by 71 publications

(49 citation statements)

References 27 publications

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“…Muitos estudos demonstram que a DRGE e a asma freqüentemente coexistem. Estudos com instilação ácida no esôfago, nos quais se logrou demonstrar broncoconstrição reflexa, são usados como argumento da relação entre essas duas afecções 46 . Estudos mostram que crianças e adolescentes com RGE freqüentemente apresentam sintomas respiratórios 20 .…”

Section: Asmaunclassified

Treatment of gastroesophageal reflux disease

Guimarães¹,

Marguet²,

Camargos³

2006

J Pediatr (Rio J)

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Objective: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.Sources: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. Summary of the findings:The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. Conclusions:The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.J Pediatr (Rio J). 2006;82(5 Suppl):S133-45: Gastroesophageal reflux, child, drug therapy, esophagitis, respiratory tract diseases, asthma. ResumoObjetivo: Rever a literatura sobre tratamento da doença do refluxo gastroesofágico (DRGE) com ênfase nos aspectos farmacológi-cos. Identificar particularidades do tratamento farmacológico nas manifestações esofágicas e extra-esofágicas da doença.Fontes de dados: Busca eletrônica na base de dados PubMed/ MEDLINE e Cochrane Collaboration. Procurou-se identificar estudos controlados e randomizados publicados a partir de 2000, bem como revisões que representassem consensos e diretrizes publicados nos últimos 10 anos.Síntese dos dados: Nenhuma das drogas atualmente usadas no tratamento da DRGE altera comprovadamente o mecanismo principal da doença, ou seja, os relaxamentos transitórios do esfíncter esofágico inferior. O tratamento farmacológico da DRGE com sintomas ou com lesões esofágicas é baseado na inibição da secreção ácida, em particular pelos inibidores da bomba de prótons (IBP). Nas situações em que a hiper-reatividade das vias aéreas inferiores coexiste com sintomas esofágicos da DRGE, a inibição da secreção ácida deve...

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Section: Asmaunclassified

Treatment of gastroesophageal reflux disease

Guimarães¹,

Marguet²,

Camargos³

2006

J Pediatr (Rio J)

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“…In contrast to the findings of the other controlled studies of medical antireflux therapy, they were unable to show an effect of high dose omeprazole on asthma symptoms. In our acid perfusion study, we found a correlation between the severity of heartburn and the changes in minute ventilation and respiratory sensation [11]. The small number of patients with heartburn and its mild nature may explain why POSTMA and coworkers [1] were unable to show that treating reflux improved asthma symptoms and asthma medication requirements.…”

Section: Omeprazole For Asthma With Gastro-oesophageal Refluxmentioning

confidence: 63%

“…To understand the effects of GOR on respiratory sensation, nonasthmatics with normal lung function underwent AP [11]. Those patients who experienced discomfort during AP, increased their minute ventilation and respiratory sensation.…”

Section: Omeprazole For Asthma With Gastro-oesophageal Refluxmentioning

confidence: 99%

Severe α<SUB>1</SUB>-antitrypsin deficiency and pregnancy

Dempsey¹,

Godden²,

Martin³

et al. 1999

Eur Respir J

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“…Animal [24] and human studies [25] confirm that distal GER may increase airways resistance and promote airway inflammation by releasing pro-inflammatory mediators [25]. FIELD et al [26] also showed that oesophageal acid increases minute ventilation, suggesting another mechanism for respiratory symptoms in GERD patients. Notwithstanding these functional changes, without aspiration parenchymal pathology does not occur.…”

Section: Mechanisms Of Respiratory Disease In Gerdmentioning

confidence: 97%

Gastro-oesophageal reflux disease and non-asthma lung disease

Morehead¹

2009

Eur Respir Rev

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Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection.Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures.Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail.Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

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The Effects of Acid Perfusion of the Esophagus on Ventilation and Respiratory Sensation

Cited by 71 publications

References 27 publications

Treatment of gastroesophageal reflux disease

Treatment of gastroesophageal reflux disease

Severe α<SUB>1</SUB>-antitrypsin deficiency and pregnancy

Gastro-oesophageal reflux disease and non-asthma lung disease

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