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)
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.
KeywordsChronic 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.
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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