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Pulmonary function and acid application in the esophagus.

L I Andersen, A Schmidt, A Bundgaard

    Chest
    |September 1, 1986
    PubMed
    Summary
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    Acid in the esophagus can cause bronchoconstriction in patients with asthma and severe esophagitis. Atropine pretreatment prevented this effect, suggesting vagal nerve involvement in this pulmonary response.

    Area of Science:

    • Gastroenterology
    • Pulmonology
    • Pharmacology

    Background:

    • Esophageal acid exposure is a known trigger for respiratory symptoms in some individuals.
    • The precise mechanisms linking esophageal conditions to pulmonary function changes remain under investigation.

    Purpose of the Study:

    • To investigate the effect of esophageal acid instillation on pulmonary function in patients with and without bronchial asthma and esophagitis.
    • To determine the role of vagal mediation in acid-induced pulmonary changes.

    Main Methods:

    • A double-blind study involving three groups: esophagitis only, asthma only, and both conditions.
    • Pulmonary function tests (TLC, Raw, RV, PEF) were measured before and after esophageal acid (0.1 N HCl) or saline instillation.
    • The effect of atropine pretreatment on acid-induced changes was assessed.

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    Main Results:

    • Esophageal acid instillation significantly decreased peak expiratory flow (PEF) and increased airway resistance (Raw) only in patients with both severe esophagitis and bronchial asthma.
    • These pulmonary function changes were not observed in patients with only esophagitis or only asthma.
    • Pretreatment with atropine abolished the acid-induced bronchoconstriction.

    Conclusions:

    • Acid in the esophagus can induce modest bronchoconstriction in patients with coexisting severe esophagitis and bronchial asthma.
    • Vagal nerve pathways appear to mediate this response, as evidenced by the inhibitory effect of atropine.