Proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease

To determine the proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease and its association with the severity and worsening of the symptoms of chronic obstructive pulmonary disease (COPD).

A prospective, questionnaire based, case control, analytical study was conducted in the Department of Pulmonology, Jinnah Postgraduate Medical Centre, Karachi during June 2002 to January 2005. Gastroesophageal reflux symptoms were compared between 100 chronic obstructive pulmonary disease patients who fulfilled the inclusion criteria and 150 control subjects. Both groups were interviewed according to modified version of Mayo clinic GER questionnaire. Chronic obstructive pulmonary disease patients were divided into two groups according to pulmonary function tests (PFTs) results into FEV1 <50% and FEV1 >50%.

Chronic obstructive pulmonary disease patients had more frequent gastroesophageal symptoms than controls (25% vs. 9.33% respectively; p=0.001), heartburn/acid regurgitation (70% vs. 43.33% and 56% vs. 30.66% respectively; p-value=0.001), dysphagia (15% vs. 4%; p-value=0.002) and chronic cough (89% vs. 29.33%; p-value=0.001). Twenty six COPD patients reported respiratory symptoms associated with reflux, whereas control subjects denied such association. Of the 11 patients with frequent gastroesophageal symptoms, 10 patients increased their inhaler use (p=0.001). Frequent gastroesophageal symptoms had shown a significant association with decreased FEV1 (25 % vs. 0% p-value 0.001). In contrast Pulmonary function test results were similar among chronic obstructive pulmonary disease patients with and without gastroesophageal symptoms (48.13+20.81 vs. 50.94+23.33). Anti-reflux medication proton pump inhibitor and H2-blockers were utilized more by COPD patients as compared to control subjects.

A higher proportion of frequent gastroesophageal symptoms were noted by COPD patients than control subjects and higher proportion of gastroesophageal symptoms was present in severe COPD patients.