Effect of positions, eating, and bronchodilators on gastroesophageal reflux in asthmatics

Gastroesophageal reflux is common in asthmatics. To determine whether bronchodilators, the supine position, or eating affect gastroesophageal reflux, we performed ambulatory 24-hr pH monitoring on 44 controls and 104 unselected adult asthmatics. All asthmatics had discrete attacks of wheezing and documented reversible airway obstruction of at least 20%. The presence or absence of gastroesophageal reflux symptoms was not used as a criterion for patient selection. Chronic bronchodilator therapy was required by 71.2% of the asthmatics, and was continued during the test. Asthmatics had significantly worse GER than controls during the 3-hr postprandial period, which continued into the nonpostprandial period up to the next meal. Significant differences were present for esophageal mucosal acid contact time, frequency of reflux episodes, and clearance times. During the nonpostprandial periods asthmatics had four times the acid reflux as controls and 19-fold the frequency of prolonged reflux episodes. There were no differences between asthmatics on bronchodilators and those not on bronchodilators in any of the reflux parameters during the upright (postprandial, nonpostprandial) period or supine (sleep) period (P = NS). We conclude that: (1) regardless of the use of bronchodilator therapy, asthmatics have significant GER when asleep and after meals that continues beyond the postprandial period to the next meal; and (2) asthmatics receiving bronchodilators have similar gastroesophageal reflux patterns after eating, in the nonpostprandial period, and when asleep as asthmatics not receiving bronchodilators.