Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease

The relation between respiratory disorders and reflux symptoms has been debated since the beginning of the last century and the interest in this question has increased during the last few decades. This study aims to investigate the relation between specified respiratory disorders and reflux symptoms and examine the correlations between respiratory disorders and endoscopic findings in patients with gastroesophageal reflux disease.

This study included 515 patients evaluated for gastroesophageal reflux disease (GERD) by patient self-report symptom questionnaire; modified four grade Likert scale and endoscopic assessment using endoscopic Los Angeles Classification. All participants were asked about various respiratory symptoms experienced during the past six months and exposed to measuring body mass index (BMI), medical history, pulmonary physical examination, chest X-ray, respiratory function tests and available sleep studies.

A total number of 515 patients were categorized according to endoscopic findings into two groups; (group1) subjects with normal endoscopic studies (NERD) 118 (22.9%) patients and (group2) subjects with abnormal endoscopic studies (ERD) 397 (77.1%). The proportion of females was significantly higher in ERD group (80.1%) as compared with NERD group (62.7%) ( P < 0.02). Duration of reflux symptoms found to be significantly prolonged in ERD group ( P < 0.03). The cases of ERD group were more likely to be overweight (BMI>25) P < 0.02. History of pulmonary symptoms preceding GERD symptoms was found in 15% of patients. There were 294 patients (57.1%) with different pulmonary manifestations. These manifestations were significantly higher among female group ( P < 0.01) and among obese, above 40 years old ( P < 0.001, 0.05 respectively). Among all patients with respiratory manifestations the commonest disorders diagnosed were chronic pharyngitis (50.3%), chronic bronchitis (15.8%), bronchial asthma (12.6%) and recurrent pneumonia (3.3%). Obstructive sleep apnea and recurrent hemoptysis were present in 2.7% and 1.5% of the studied patients respectively. There were three cases of chronic lung abscess. There was a significant difference between ERD and NERD groups in their relations to respiratory disorders ( P < 0.001). There were statistically significant differences in FEV1, FVC and FEV1/FVC ( P < 0.02, P < 0.05 and P < 0.05) respectively in ERD group as compared with NERD group.

The study confirms the strong link between gastroesophageal reflux symptoms and various respiratory disorders. Endoscopy of the upper digestive tract remains an important exam in the evaluation of GERD. Respiratory symptoms are more prevalent among erosive esophagitis patients with a positive correlation with degree of severity. There is direct relationship between the severity of airways obstruction as detected by FEV1 and FEV1/FVC and GER symptoms.