Digestive Diseases and Sciences

, Volume 42, Issue 6, pp 1184–1188 | Cite as

Esophageal Dysmotility and Gastroesophageal Reflux in Intrinsic Asthma

  • Salvatore Campo
  • Sergio Morini
  • Maria Antonietta Re
  • Danilo Monno
  • Roberto Lorenzetti
  • Barbara Moscatelli
  • Enrico Bologna


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.



Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mays EE: Intrinsic asthma in adults, association with gastroesophageal reflux. JAMA 236:2626–2628, 1976Google Scholar
  2. 2.
    Goodall RJR, Earis JE, Cooper DN, Bernstein A, Temple JG: Relationship between asthma and gastro-oesophageal reflux. Thorax 36:116–121, 1981Google Scholar
  3. 3.
    Wilson NM, Charette L, Thomson AH, Silverman M: Gastrooesophageal reflux and childhood asthma: the acid test. Thorax 40:592–597, 1985Google Scholar
  4. 4.
    Wilson N, Chudry N, Silverman M: Role of the esophagus in asthma induced by the ingestion of ice and acid. Thorax 42:506–510, 1987Google Scholar
  5. 5.
    Sontag SJ, Schnell TG, Miller TQ, Khandelwal S, O'Connell S, Chejfec G, Greenlee H, Seidel UJ, Brand L: Prevalence of oesophagitis in asthmatics. Gut 33:872–876, 1992Google Scholar
  6. 6.
    Johnson LF, DeMeester TR: Twenty-four hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332, 1974Google Scholar
  7. 7.
    Mattox HE, Richter JE: Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. Am J Med 89:345–356, 1990Google Scholar
  8. 8.
    Patti MG, Debas HT, Pellegrini CA: Esophageal manometry and 24-hour pH monitoring in the diagnosis of pulmonary aspiration secondary to gastroesophageal reflux. Am J Surg 163:401–406, 1992Google Scholar
  9. 9.
    Henderson RD, Mugashe F, Jeejeebhoy KN: The motor defect of esophagitis. Can J Surg 17:112–116, 1974Google Scholar
  10. 10.
    Kahrilas PJ, Dodds WJ, Hogan WJ: Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91:897–904, 1986Google Scholar
  11. 11.
    Campo S, Traube M: Lower esophageal sphincter dysfunction in diffuse esophageal spasm. Am J Gastroenterol 84:928–932, 1989Google Scholar
  12. 12.
    Campo S, Traube M: Manometric characteristics in idiopathic and reflux-associated esophageal spasm. Am J Gastroenterol 87:187–189, 1992Google Scholar
  13. 13.
    Sontag SJ, O'Connell S, Khandelwal S, Miller T, Nemchausky B, Schnell TG, Serlovsky R: Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. Gastroenterology 99:613–620, 1990Google Scholar
  14. 14.
    Kjellen G, Tibbling L, Wranne B: Oesophageal function in asthmatics. Eur J Respir Dis 62:87–94, 1981Google Scholar
  15. 15.
    Bonmarchand G, Denis P, Weber J: Motor abnormalities of digestive and urinary tracts in patients on ventilator for acute exacerbation of chronic obstructive pulmonary disease. Dig Dis Sci 34:1231–1237, 1989Google Scholar
  16. 16.
    Ekstrom T, Lindgren BR, Tibbling L: Effects of ranitidine treatment on patients with asthma and a history of gastroeioesophageal reflux: A double blind crossover study. Thorax 44:19–23, 1989Google Scholar
  17. 17.
    Harding SM, Richter JE, Guzzo MR, Schan CA, Alexander RW, Bradley LA: Asthma and gastroesophageal reflux: Acid suppressive therapy improves asthma outcome. Am J Med 100:395–405, 1996Google Scholar
  18. 18.
    Mays EE: Intrinsic asthma in adults: Association with gastroesophageal reflux. JAMA 236:2626–2628, 1976Google Scholar
  19. 19.
    Cockcroft DW, and Kalra S: Outpatient asthma management. Med Clin North Am 80:701–703, 1996Google Scholar
  20. 20.
    American Thoracic Society: Definitions and classifications of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 85:762–768, 1962Google Scholar
  21. 21.
    Cropp GJA, Bernstein IL, Boushey HA, Hyde RW: Guidelines for bronchial inhalation challenges with pharmacologic and antigenic agents. Am Thorac Soc Bull 6:11–19, 1980Google Scholar
  22. 22.
    Hetzel DJ, Dent J, Reed WD, Narielvala FM, Mackinnon M, McCarthy JH, Mitchell B, Beveridge BR, Laurence BH, Gibson GG, Grant AK, Shearman DJC, Whitehead R, Buckle PJ: Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology 95:903–912, 1988Google Scholar
  23. 23.
    Behar J, Sheahan DC: Histologic abnormalities in reflux esophagitis. Arch Pathol Lab Med 99:387, 1975Google Scholar
  24. 24.
    Richter JE, Castell DO: Diffuse esophageal spasm: a reappaisal. Ann Intern Med 100:242–245, 1984Google Scholar
  25. 25.
    Traube M, McCallum RW: Primary oesophageal motility disorders: Current therapeutic concepts. Drugs 30:66–77, 1985Google Scholar
  26. 26.
    De Meester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG: Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–670, 1980Google Scholar
  27. 27.
    Giudicelli R, Dupin B, Surpas P, Badier M, Charpin D: Gastroesophageal reflux and respiratory manifestations: Diagnostic approach, therapeutic indications and results. Ann Chir 44:552–554, 1990Google Scholar
  28. 28.
    Spaulding HS, Mansfield LE, Stein MR, Sellner JC, Gremillion DE: Further investigation of the association between gastroesophageal reflux and broncoconstriction. J Allergy Clin Immunol 69:516–521, 1982Google Scholar
  29. 29.
    Herve P, Denjean A, Jian R, Simonneau G, Duroux P: Intraesophageal perfusion of acid increases the bronchomotor response to methacoline and to isocapnic hyperventilation in asthmatic subjects. Am Rev Respir Dis 134:986–989, 1986Google Scholar
  30. 30.
    Fayolle MP, Gormand F, Braillon G, Lombard-Platet R, Vignal J, Azzar D, Forichon J, Adeline P: Long-term results of surgical treatment for gastroesophageal reflux in asthmatics patients. Chest 96:40–45, 1989Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Salvatore Campo
  • Sergio Morini
  • Maria Antonietta Re
  • Danilo Monno
  • Roberto Lorenzetti
  • Barbara Moscatelli
  • Enrico Bologna

There are no affiliations available

Personalised recommendations