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



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.


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


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.


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.


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.


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



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.


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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

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