Airway reflux as a cause of respiratory disease

Posted On Oct 10 2009 by

As a consequence of our upright posture, the oesophagus hangs vertically and the lower oesophageal sphincter (LOS) is located directly above the stomach. In quadrupeds, there is a right angle between the oesophagus and stomach, aiding LOS closure. A second evolutionary adaption which makes human beings prone to aspiration is in the laryngeal apparatus. In all other mammals, the soft palate, arytenoid cartilage and epiglottis form a highly efficient valve preventing aspiration of matter into the respiratory tract. In babies, the same mechanism applies.

Further investigation is needed to more definitively clarify the role of GER treatment in the care of IPF. The results of studies evaluating anti-reflux surgical interventions for IPF will inform our understanding of the pathogenic function of duodenogastric reflux, where surgery is a more definitive therapy for bile acid reflux.

If she says that she is doing all that can be done and you still continue to have these symptoms, talk with your family doctor about referring you to a specialist. Thanks so much. I’ve not been diagnosed with GERD (had endoscopy last summer), but had periods of really bad acid reflux, but is OK now. They put me on PPI (Nexium) but now my Dr says to stop taking it because of recent news about harmful effects of PPI. So, I’ve been off of it for about 3 months and doing fine, no problems.

The diagnosis of GERD only requires distinct reflux symptoms, whereas RE requires mucosal changes in the esophagus, and GER is confirmed by measuring esophageal pH through 24 hour ambulatory pH monitoring [14,16]. Most studies of GERD in COPD have used self-reported questionnaires [4,6,8,9,10,11] though some have measured esophageal pH [7,15].

They found nasal discharge in 43.4% of participants, which was associated with more cough and sputum symptoms, whereas postnasal drip, found in 13.1%, was associated with more cough. Experts know that about 10%-15% of people with COPD also have sleep apnea, a condition that causes you to stop breathing for several seconds at a time while you’re asleep. One treatment for sleep apnea, called CPAP (continuous positive airway pressure), is well-known for causing bloating and gas pains because air pushed in from the device can end up in your stomach. Whatever the cause for either disease, it is important to seek out proper treatment. Increased symptomology for COPD and GERD can wreak havoc on the other condition.

Asymptomatic aspiration of oropharyngeal secretion or gastric fluid into the lungs is called silent microaspiration. It has been demonstrated that approximately half of normal adults experience mild silent microaspiration during sleep at night [19 ]. Normally, natural defenses, including coughing and epiglottic closure, are protective against microaspiration. Depending on the individual, sometimes these defenses become impaired and cause wheezing and coughing [20 ]. Heartburn and gastroesophageal reflux disease (GERD).

GERD, when defined by weekly symptoms and/or acid regurgitation, is very common, affecting 10-20 % of people in the Western world [8 ]. GER has a variety of possible causes, and the association between age and development of reflux is unclear. Idiopathic pulmonary fibrosis is a chronic fibrosing disease of the lung and is the most common of the interstitial pneumonias.

What’s more, GERD can worsen COPD symptoms, which include frequent coughing and difficulty breathing. GERD can trigger an acute and serious flare-up of COPD symptoms, like coughing up sputum and extreme shortness of breath, because the acids moving up from the stomach into the esophagus can also get into the lungs.

has proved a useful biomarker for aspiration in lung transplant recipients [45 ]. It has been previously hypothesized that acute exacerbations of IPF may be caused by microaspiration [46 ]. Pepsin levels in BAL fluid from patients experiencing exacerbations of IPF were significantly elevated compared to levels of control patients with stable disease [47 •]. It remains to be determined whether pepsin levels differ, and if so by how much, for stable patients with IPF or patients in the early stages of disease compared with healthy controls. In scleroderma, the relationship between esophageal dysfunction and ILD has been a topic of active investigation, but remains unknown.

The prevalence of GERD in patients with pulmonary disease, including COPD, was 20% higher than those with other conditions except pulmonary disease [6]. Several studies measuring esophageal pH have shown similar results [7,15]. However, patients with symptoms suggesting GER do not always have RE [24], and even if reflux of gastric acid at the esophagogastric junction occurs, it does not always cause symptoms [7,15] or mucosal changes in the esophagus. Although we did not use a prospectively designed systematic questionnaire, we collected data as to whether patients presented with one of four symptoms-heartburn, regurgitation, epigastric pain, and dyspepsia-by reviewing medical records. More than three-quarters of the subjects complained of one or more of those symptoms.

More Than a Feeling: Tired vs COPD Tired

The prevalence of GERD in individuals with COPD has been explored in a number of studies.11,41,42,49,52-57 A range of diagnostic tools have been used, including symptom questionnaires and objective measurements, outlined in Table 1. Based on self-reported symptoms and questionnaires, the prevalence of GERD ranges from 17% to 54%.12,52-55,57-61 Variation is partially attributable to the heterogeneity of questionnaire content. However, while typical GERD symptoms exhibit a sensitivity of 90%, the specificity is as low as 47%,10 which may limit their diagnostic value.

Pulmonary manifestations of gastroesophageal reflux disease

Heartburn, coughing more frequently, coughing up mucus, and having even more trouble catching your breath all indicate that GERD is likely making your COPD symptoms worse. According to the studies in the literature, pathological GERD can be found in 30% to 80% of patients with asthma.

gerd cause copd

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