Reflex mechanisms in gastroesophageal reflux disease and asthma

This article presents a brief description of the reflex mechanisms responsible for cough and bronchospasm, and identifies several potential mechanisms by which gastroesophageal reflux (GER) may precipitate these reflexes. Airway and esophageal reflexes related to various mechanoreceptors and chemoreceptors have been elucidated, primarily in animal studies. Central nervous system (CNS) reflex pathways as well as local axon reflexes may each contribute to the pathogenesis of both asthma and GER disease (GERD). When activated, airway nociceptors precipitate defensive reflexes such as cough, bronchospasm, and mucus secretion. Nociceptors innervating both the airways and the esophagus respond to similar stimuli with defensive manuevers. The pathways of some esophageal and airway sensory nerves terminate in the same regions of the CNS. It appears possible that synergistic interactions between esophageal nociceptors and airway sensory nerves may precipitate the asthma-like symptoms associated with GERD.