Advertisement

Journal of Gastrointestinal Surgery

, Volume 20, Issue 10, pp 1679–1682 | Cite as

Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)

  • Leonardo M. Del Grande
  • Fernando A. M. Herbella
  • Amilcar M. Bigatao
  • Jose R. Jardim
  • Marco G. Patti
2016 SSAT Poster Presentation

Abstract

Background

Chronic obstructive pulmonary disease (COPD) patients have a high incidence of gastroesophageal reflux disease (GERD) whose pathophysiology seems to be linked to an increased trans-diaphragmatic pressure gradient and not to a defective esophagogastric barrier. Inhaled beta agonist bronchodilators are a common therapy used by patients with COPD. This drug knowingly not only leads to a decrease in the lower esophageal sphincter (LES) resting pressure, favoring GERD, but also may improve ventilatory parameters, therefore preventing GERD.

Aims

This study aims to evaluate the effect of inhaled beta agonist bronchodilators on the trans-diaphragmatic pressure gradient and the esophagogastric barrier.

Methods

We studied 21 patients (mean age 67 years, 57 % males) with COPD and GERD. All patients underwent high-resolution manometry and esophageal pH monitoring. Abdominal and thoracic pressure, trans-diaphragmatic pressure gradient (abdominal–thoracic pressure), and the LES retention pressure (LES basal pressure–transdiaphragmatic gradient) were measured before and 5 min after inhaling beta agonist bronchodilators.

Results

The administration of inhaled beta agonist bronchodilators leads to the following: (a) a simultaneous increase in abdominal and thoracic pressure not affecting the trans-diaphragmatic pressure gradient and (b) a decrease in the LES resting pressure with a reduction of the LES retention pressure.

Conclusion

In conclusion, inhaled beta agonist bronchodilators not only increase the thoracic pressure but also lead to an increased abdominal pressure favoring GERD by affecting the esophagogastric barrier.

Keywords

Chronic obstructive pulmonary disease Gastroesophageal reflux disease Trans-diaphragmatic pressure gradient Bronchodilators High-resolution manometry Ambulatory pH monitoring 

Notes

Acknowledgments

We are indebted to Ms. Vanessa Horich Tuxen for her invaluable assistance with the esophageal tests.

Authors’ Contributions

LMDG was involved in analysis and interpretation of data and final approval of the version to be published. FAMH contributed to conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. AMB was involved in acquisition of data, analysis and interpretation of data, and final approval of the version to be published. JRJ did the review for intellectual content and final approval of the version to be published. MGP contributed to conception and design, analysis and interpretation of data, review for intellectual content, and final approval of the version to be published.

Compliance with Ethical Standards

The study protocol was approved by the local Ethics Committee (#1960/11) and written informed consent was obtained from each subject.

References

  1. 1.
    Allaix ME, Fisichella PM, Noth I, Mendez BM, Patti MG. The pulmonary side of reflux disease: from heartburn to lung fibrosis. J Gastrointest Surg. 2013;17(8):1526–35.CrossRefPubMedGoogle Scholar
  2. 2.
    Harding SM. Recent clinical investigations examining the association of asthma and gastroesophageal reflux. Am J Med. 2003;115 Suppl 3A:39S-44S.CrossRefPubMedGoogle Scholar
  3. 3.
    Kahrilas PJ, Smith JA, Dicpinigaitis PV. A Causal Relationship Between Cough and Gastroesophageal Reflux Disease (GERD) has been Established: A Pro/Con Debate. Lung. 2014 ;192(1):39–46.CrossRefPubMedGoogle Scholar
  4. 4.
    Allaix ME, Fisichella PM, Noth I, Herbella FA, Borraez Segura B, Patti MG. Idiopathic pulmonary fibrosis and gastroesophageal reflux. Implications for treatment. J Gastrointest Surg. 2014;18(1):100–5CrossRefPubMedGoogle Scholar
  5. 5.
    Del Grande LM, Herbella FA, Bigatao AM, Abrao H, Jardim JR, Patti MG. Pathophysiology of gastroesophageal reflux in patients with chronic pulmonary obstructive disease is linked to an increased transdiafragmatic pressure gradient and not to a defective esophagogstric barrier. J Gastrointest Surg. 2016; 20(1): 104–10. doi  10.1007/s11605-015-2955-4 CrossRefPubMedGoogle Scholar
  6. 6.
    Herbella FA, Patti MG. Gastroesophageal reflux disease: From pathophysiology to treatment. World J Gastroenterol. 2010;16(30):3745–9CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Casanova C, Baudet JS, del Valle Velasco M, Martin JM, Aguirre-Jaime A, de Torres JP, Celli BR. Increased gastro-oesophageal reflux disease in patients with severe COPD. Eur Respir J. 2004;23(6):841–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Kempainen RR, Savik K, Whelan TP, Dunitz JM, Herrington CS, Billings JL. High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. Chest. 2007;131(6):1666–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Crowell MD1, Zayat EN, Lacy BE, Schettler-Duncan A, Liu MC. The effects of an inhaled beta(2)-adrenergic agonist on lower esophageal function: a dose-response study. Chest. 2001;120(4):1184–9.Google Scholar
  10. 10.
    Ozkaya S, Dirican A, Kaya SO, Karanfil RC, Bayrak MG, Bostancı O, Ece F. The relationship between early reversibility test and maximal inspiratory pressure in patients with airway obstruction. Int J Chron Obstruct Pulmon Dis. 2014;9:453–6. doi:  10.2147/COPD.S58584. eCollection 2014CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Nadaleto BF, Herbella FA, Patti MG. Gastroesophageal reflux disease in the obese: Pathophysiology and treatment. Surgery. 2016;159(2):475–86. doi:  10.1016/j.surg.2015.04.034.CrossRefPubMedGoogle Scholar
  12. 12.
    Herregods TV, van Hoeij FB, Oors JM, Bredenoord AJ, Smout AJ. Effect of Running on Gastroesophageal Reflux and Reflux Mechanisms. Am J Gastroenterol. 2016. doi:  10.1038/ajg.2016.122 PubMedGoogle Scholar
  13. 13.
    Ayazi S, DeMeester SR, Hsieh CC, Zehetner J, Sharma G, Grant KS, Oh DS, Lipham JC, Hagen JA, DeMeester TR. Thoraco-abdominal pressure gradients during the phases of respiration contribute to gastroesophageal reflux disease. Dig Dis Sci. 2011;56(6):1718–22. doi:  10.1007/s10620-011-1694-y.CrossRefPubMedGoogle Scholar
  14. 14.
    Maddison KJ, Shepherd KL, Hillman DR, Eastwood PR. Function of the lower esophageal sphincter during and after high-intensity exercise. Med Sci Sports Exerc. 2005;37(10):1728–33.CrossRefPubMedGoogle Scholar
  15. 15.
    Herbella FA, Aprile LR, Patti MG. High-resolution manometry for the evaluation of gastric motility. Updates Surg. 2014;66(3):177–81. doi:  10.1007/s13304-014-0261-4.CrossRefPubMedGoogle Scholar
  16. 16.
    Duranti R, Filippelli M, Bianchi R, et al. Inspiratory capacity and decrease in lung hyperinflation with albuterol in COPD. Chest 2002;122:2009–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Polkey MI, Kyroussis D, Hamnegard CH, et al. Diaphragm performance during maximal voluntary ventilation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;155:642–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Aliverti A, Rodger K, Dellaca R, et al. Effect of salbutamol on lung function and chest wall volumes at rest and during exercise in COPD. Thorax. 2005;60(11):916–924. doi: 10.1136/thx.2004.037937.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Orr WC, Shamma-Othman Z, Allen M, Robinson MG. Esophageal function and gastroesophageal reflux during sleep and waking in patients with chronic obstructive pulmonary disease. Chest. 1992;101(6):1521–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Sarma DN, Banwait K, Basak A, DiMarino AJ, Rattan S. Inhibitory effect of beta3-adrenoceptor agonist in lower esophageal sphincter smooth muscle: in vitro studies. J Pharmacol Exp Ther. 2003;304(1):48–55.CrossRefPubMedGoogle Scholar
  21. 21.
    Kim J, Lee JH, Kim Y, Kim K, Oh YM, Yoo KH, Rhee CK, Yoon HK, Kim YS, Park YB, Lee SW, Lee SD. Association between chronic obstructive pulmonary disease and gastroesophageal reflux disease: a national cross-sectional cohort study. BMC Pulm Med. 2013;13:51. doi:  10.1186/1471-2466-13-51.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Leonardo M. Del Grande
    • 1
  • Fernando A. M. Herbella
    • 1
  • Amilcar M. Bigatao
    • 2
  • Jose R. Jardim
    • 2
  • Marco G. Patti
    • 3
  1. 1.Department of Surgery, Escola Paulista de MedicinaFederal University of Sao PauloSao PauloBrazil
  2. 2.Department of Medicine, Respiratory Division, Escola Paulista de MedicinaFederal University of Sao PauloSao PauloBrazil
  3. 3.Department of Surgery, Pritzker School of MedicineUniversity of ChicagoChicagoUSA

Personalised recommendations