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 26 May 2018

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Asthmatics with gastroesophageal reflux

In patients with both gastroesophageal reflux and asthma, antireflux surgery improves asthma symptoms and overall clinical status, finds a research team in the May issue of the American Journal of Gastroenterology.

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Asthma symptoms and pulmonary function have been reported to improve during, and after, medical treatment or surgical correction of gastroesophageal reflux.

In this study, researchers from the United States determined whether prolonged treatment of gastroesophageal reflux altered the long term natural history of asthma in asthmatics. The team studied 62 patients with both gastroesophageal reflux and asthma. Patients were randomized to 1 of 3 antireflux treatments for at least 2 years.

Asthma improvement occurred in 75% of the surgical group.
American Journal of Gastroenterology

The 24 controls received antacids as needed, while 22 patients received medical therapy (ranitidine 150 mg t.i.d.), and 16 underwent surgery (Nissen fundoplication).

The researchers defined asthma as a previous diagnosis of asthma with discrete attacks of wheezing and 20% reversibility in airway disease.

Gastroesophageal reflux was defined as an abnormal ambulatory 24-hour esophageal pH test, plus macroscopic or microscopic evidence of gastroesophageal disease.

The team recorded patients' overall clinical status, asthma symptom scores, and pulmonary medication requirements monthly.

They also recorded peak expiratory flow rates up to 7 times a day for 1 week each month.

Pulmonary function, esophageal manometry, and endoscopy with biopsy were repeated yearly.

The 62 patients were followed for up to 19.1 years.

The researchers found an immediate and sustained reduction in acute nocturnal exacerbations of wheezing, coughing, and dyspnea in the surgical group only.

They found that by the end of the second year, an asthma improvement or cure occurred in 75% of the surgical group, 9% of the medical group and 4% of the control group.

However, the team also determined that overall status worsened in 48% of the control group, 36% of the medical group, and 13% of the surgical group.

Overall, the researchers found that the mean asthma symptom score in the surgical group improved by 43%, compared with less than 10% in the medical and control groups.

The team did not identify any statistically significant difference in pulmonary function during the 2-year period, or during follow-up.

There was no difference in medication requirements between the groups, and there was no difference in overall survival.

Dr Stephen Sontag's team concluded, "In patients with both gastroesophageal reflux and asthma, antireflux surgery…has minimal effect on pulmonary function…but significantly improves asthma symptoms and overall clinical status".

Am J Gastroenterol 2003; 98(5): 987-99
17 June 2003

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