Abstract
This study was undertaken to determine theprevalence of esophageal motor abnormalities, theincidence of gastroesophageal reflux, and thecoexistence of gastroesophageal reflux with esophagealdysmotility in patients with intrinsic asthma. Based onclinical criteria, 34 consecutive asthmatics, 15patients with gastroesophageal reflux, and 10 subjectswith upper gastrointestinal symptoms with normal results of esophageal manometry and 24-hr esophageal pHtest (controls) were studied. Esophageal motor disorderswere noted in 23 of 34 asthmatics, and in 10 of 15patients with acid reflux but in none of the subjects of the control group. A positive result of theprolonged esophageal pH study (pH in the distalesophagus less than 4 for more than 4.2% of therecording time) was obtained in 14 of 17 patients withasthma (only 17 of the original patients were testedbecause the others did not give informed consence forthis test) and in all patients with gastroesophagealreflux. None of the members of the control group had positive test results. The findings of thisstudy show that: (1) it is possible to identify a groupof subjects with nonallergic asthma presenting withesophageal dysmotility, (2) the 24-hr esophageal pH study must be properly done in suchpatients; (3) esophageal motor abnormalities are oftenassociated with positive pH results; and (4) more refluxwas observed while in a supine position (especially during the night) than that observed either incontrol or reflux patients. Based on these results,patients with intrinsic asthma with reflux can benefitfrom both acid suppressive and prokinetic drugs with notable clinical implications regardingstandard treatment for asthma, and those with prevalentsupine compared to upright reflux could even benefitfrom surgery.
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REFERENCES
Mays EE: Intrinsic asthma in adults, association with gastroesophageal reflux. JAMA 236:2626–2628, 1976
Goodall RJR, Earis JE, Cooper DN, Bernstein A, Temple JG: Relationship between asthma and gastro-oesophageal reflux. Thorax 36:116–121, 1981
Wilson NM, Charette L, Thomson AH, Silverman M: Gastrooesophageal reflux and childhood asthma: the acid test. Thorax 40:592–597, 1985
Wilson N, Chudry N, Silverman M: Role of the esophagus in asthma induced by the ingestion of ice and acid. Thorax 42:506–510, 1987
Sontag SJ, Schnell TG, Miller TQ, Khandelwal S, O'Connell S, Chejfec G, Greenlee H, Seidel UJ, Brand L: Prevalence of oesophagitis in asthmatics. Gut 33:872–876, 1992
Johnson LF, DeMeester TR: Twenty-four hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332, 1974
Mattox HE, Richter JE: Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. Am J Med 89:345–356, 1990
Patti MG, Debas HT, Pellegrini CA: Esophageal manometry and 24-hour pH monitoring in the diagnosis of pulmonary aspiration secondary to gastroesophageal reflux. Am J Surg 163:401–406, 1992
Henderson RD, Mugashe F, Jeejeebhoy KN: The motor defect of esophagitis. Can J Surg 17:112–116, 1974
Kahrilas PJ, Dodds WJ, Hogan WJ: Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91:897–904, 1986
Campo S, Traube M: Lower esophageal sphincter dysfunction in diffuse esophageal spasm. Am J Gastroenterol 84:928–932, 1989
Campo S, Traube M: Manometric characteristics in idiopathic and reflux-associated esophageal spasm. Am J Gastroenterol 87:187–189, 1992
Sontag SJ, O'Connell S, Khandelwal S, Miller T, Nemchausky B, Schnell TG, Serlovsky R: Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. Gastroenterology 99:613–620, 1990
Kjellen G, Tibbling L, Wranne B: Oesophageal function in asthmatics. Eur J Respir Dis 62:87–94, 1981
Bonmarchand G, Denis P, Weber J: Motor abnormalities of digestive and urinary tracts in patients on ventilator for acute exacerbation of chronic obstructive pulmonary disease. Dig Dis Sci 34:1231–1237, 1989
Ekstrom T, Lindgren BR, Tibbling L: Effects of ranitidine treatment on patients with asthma and a history of gastroeioesophageal reflux: A double blind crossover study. Thorax 44:19–23, 1989
Harding SM, Richter JE, Guzzo MR, Schan CA, Alexander RW, Bradley LA: Asthma and gastroesophageal reflux: Acid suppressive therapy improves asthma outcome. Am J Med 100:395–405, 1996
Mays EE: Intrinsic asthma in adults: Association with gastroesophageal reflux. JAMA 236:2626–2628, 1976
Cockcroft DW, and Kalra S: Outpatient asthma management. Med Clin North Am 80:701–703, 1996
American Thoracic Society: Definitions and classifications of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 85:762–768, 1962
Cropp GJA, Bernstein IL, Boushey HA, Hyde RW: Guidelines for bronchial inhalation challenges with pharmacologic and antigenic agents. Am Thorac Soc Bull 6:11–19, 1980
Hetzel DJ, Dent J, Reed WD, Narielvala FM, Mackinnon M, McCarthy JH, Mitchell B, Beveridge BR, Laurence BH, Gibson GG, Grant AK, Shearman DJC, Whitehead R, Buckle PJ: Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology 95:903–912, 1988
Behar J, Sheahan DC: Histologic abnormalities in reflux esophagitis. Arch Pathol Lab Med 99:387, 1975
Richter JE, Castell DO: Diffuse esophageal spasm: a reappaisal. Ann Intern Med 100:242–245, 1984
Traube M, McCallum RW: Primary oesophageal motility disorders: Current therapeutic concepts. Drugs 30:66–77, 1985
De Meester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG: Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–670, 1980
Giudicelli R, Dupin B, Surpas P, Badier M, Charpin D: Gastroesophageal reflux and respiratory manifestations: Diagnostic approach, therapeutic indications and results. Ann Chir 44:552–554, 1990
Spaulding HS, Mansfield LE, Stein MR, Sellner JC, Gremillion DE: Further investigation of the association between gastroesophageal reflux and broncoconstriction. J Allergy Clin Immunol 69:516–521, 1982
Herve P, Denjean A, Jian R, Simonneau G, Duroux P: Intraesophageal perfusion of acid increases the bronchomotor response to methacoline and to isocapnic hyperventilation in asthmatic subjects. Am Rev Respir Dis 134:986–989, 1986
Fayolle MP, Gormand F, Braillon G, Lombard-Platet R, Vignal J, Azzar D, Forichon J, Adeline P: Long-term results of surgical treatment for gastroesophageal reflux in asthmatics patients. Chest 96:40–45, 1989
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Campo, S., Morini, S., Re, M.A. et al. Esophageal Dysmotility and Gastroesophageal Reflux in Intrinsic Asthma. Dig Dis Sci 42, 1184–1188 (1997). https://doi.org/10.1023/A:1018841704897
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DOI: https://doi.org/10.1023/A:1018841704897