[Gastroesophageal reflux and lung diseases]

In a number of patients there is evidence of an unfavourable interaction between gastro-oesophageal reflux (GER) and pulmonary disease, that takes the form of a vicious circle: first GER can induce and maintain chronic bronchopulmonary inflammation by recurrent unnoticed aspirations and, secondly chemical irritation of the oesophageal mucosa causes airway obstruction by vagally-mediated reflexes. Obstructive airway disease in turn favours GER via anatomical functional and physiological factors. Thus the prevalence of GER is increased to 30-40% in patients with asthma and chronic bronchitis, as compared with only 5-10% in the general population. A positive history of productive cough, nocturnal respiratory symptoms and recurrent hoarseness may be helpful in detecting an important relationship between GER and chronic airway disease. The modified Bernstein-test, radionuclide studies and detailed sleep studies are suitable methods of establishing the diagnosis. Antireflux diets, H2-antagonists and antacids are accepted treatment in the adult, and may obviate surgical procedures in most patients. In clinical practice the relationship between GER and pulmonary diseases should be considered routinely, in order to initiate early and effective treatment and to end the vicious circle.