, Volume 42, Issue 6, pp 1184-1188

Esophageal Dysmotility and Gastroesophageal Reflux in Intrinsic Asthma

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Abstract

This study was undertaken to determine theprevalence of esophageal motor abnormalities, theincidence of gastroesophageal reflux, and thecoexistence of gastroesophageal reflux with esophagealdysmotility in patients with intrinsic asthma. Based onclinical criteria, 34 consecutive asthmatics, 15patients with gastroesophageal reflux, and 10 subjectswith upper gastrointestinal symptoms with normal results of esophageal manometry and 24-hr esophageal pHtest (controls) were studied. Esophageal motor disorderswere noted in 23 of 34 asthmatics, and in 10 of 15patients with acid reflux but in none of the subjects of the control group. A positive result of theprolonged esophageal pH study (pH in the distalesophagus less than 4 for more than 4.2% of therecording time) was obtained in 14 of 17 patients withasthma (only 17 of the original patients were testedbecause the others did not give informed consence forthis test) and in all patients with gastroesophagealreflux. None of the members of the control group had positive test results. The findings of thisstudy show that: (1) it is possible to identify a groupof subjects with nonallergic asthma presenting withesophageal dysmotility, (2) the 24-hr esophageal pH study must be properly done in suchpatients; (3) esophageal motor abnormalities are oftenassociated with positive pH results; and (4) more refluxwas observed while in a supine position (especially during the night) than that observed either incontrol or reflux patients. Based on these results,patients with intrinsic asthma with reflux can benefitfrom both acid suppressive and prokinetic drugs with notable clinical implications regardingstandard treatment for asthma, and those with prevalentsupine compared to upright reflux could even benefitfrom surgery.