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Asthma and gastroesophageal reflux
T M Hisel1, K Bielefeldt, J D Joss
1Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
The Journal of the American Osteopathic Association
|January 7, 2000
Summary
Gastroesophageal reflux (GER) may contribute to asthma development and worsening. Acid-suppressive therapy is a cost-effective initial treatment for asthmatic patients with GER symptoms.
Area of Science:
- Gastroenterology and Pulmonology
- Medical Research
Background:
- Gastroesophageal reflux (GER) and asthma are prevalent conditions in developed countries.
- Coexistence of GER and asthma is common, with evidence suggesting GER's role in asthma pathogenesis.
- GER symptoms can manifest as nocturnal asthma exacerbations or postprandial pulmonary symptom worsening.
Purpose of the Study:
- To explore the relationship between gastroesophageal reflux and asthma.
- To evaluate treatment strategies for patients with comorbid GER and asthma.
- To identify optimal diagnostic and therapeutic pathways for this patient population.
Main Methods:
- Review of animal experiments, epidemiologic data, and clinical studies.
- Analysis of treatment outcomes for acid-suppressive regimens.
- Consideration of diagnostic studies for complicated reflux disease.
- Evaluation of surgical interventions like fundoplication.
Main Results:
- Empiric acid-suppressive therapy is cost-effective for asthmatic patients with classic GER symptoms, particularly when asthma is poorly controlled.
- Persistent symptoms or complicated GER (e.g., dysphagia) warrant further diagnostic evaluation.
- Medical therapy is generally the preferred long-term treatment for comorbid GER and asthma.
Conclusions:
- GER is a significant factor in asthma management, necessitating targeted treatment.
- Acid-suppressive therapy offers a valuable, cost-effective initial approach.
- Laparoscopic fundoplication is a viable alternative for select patients with documented, responsive reflux.