Pathophysiology of Gastroesophageal Reflux in Patients with Chronic Pulmonary Obstructive Disease Is Linked to an Increased Transdiaphragmatic Pressure Gradient and not to a Defective Esophagogastric Barrier
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The association of gastroesophageal reflux disease (GERD) and pulmonary diseases is well known.1 Early studies showed that gastroduodenal contents may reflux up to the proximal esophagus2 and cause aspiration.3 Other studies showed a higher incidence of GERD in patients with asthma,4 interstitial fibrosis,5 chronic cough,6 and chronic obstructive pulmonary disease (COPD).7, 8, 9, 10
Esophageal (or typical) GERD symptoms (heartburn, regurgitation, and dysphagia) are not always present in these patients, and even when they are reported, they yield a low accuracy for GERD diagnosis.11 Extra-esophageal symptoms such as cough are common and thus represent a confounding factor. As a consequence, clinical questionnaires are insufficient and objective determination of GERD is mandatory for the correct management of these patients.
COPD is attributed to tobacco smoking in the majority of cases, different from adult asthma and pulmonary fibrosis that, although still considered...
KeywordsGastroesophageal reflux Chronic obstructive pulmonary disease High-resolution esophageal manometry Esophageal pH monitoring
We are indebted to Ms. Vanessa Horich Tuxen for her invaluable assistance with the esophageal tests.
LMDG participated in the analysis and interpretation of data as well as final approval of the version to be published
FAMH participated in the conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published
AMB participated in the acquisition of data, analysis and interpretation of data, and final approval of the version to be published
HA participated in the analysis and interpretation of data, final approval of the version to be published
JRJ reviewed the manuscript for intellectual content and for final approval of the version to be published
MGP participated in the conception and design, analysis and interpretation of data, review for intellectual content, and final approval of the version to be published
The study protocol was approved by the local ethics committee (#1960/11) and written informed consent was obtained from each subject. No financial compensation was provided to the individuals.
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