Dear editor
With interest we read the article by Jung et alCitation1 published in the recent issue of the International Journal of Chronic Obstructive Pulmonary Disease. An important finding of the study was the positive correlation between symptoms of gastroesophageal reflux disease (GERD), endoscopic signs for laryngopharyngeal reflux (LPR), and COPD.Citation1 COPD represents an increasing health burden.Citation2,Citation3 Owing to the symptoms, COPD impairs the productivity and life quality of those affected.Citation2,Citation3 Frequently, COPD requires chronic administration of cortisone therapy, which itself produces side effects impairing well being.Citation4,Citation5 The finding that COPD associates with LPR and GERD opens the trail for additional diagnostic and therapeutic considerations.
If GERD is suspected, one may want to define the amount, characteristics, and components of GERD. Thus, endoscopy and histopathology of esophageal biopsies help to assess the morphologic manifestation of GERD, ie, hiatal hernia, esophagitis, and columnar lined esophagus in the distal or proximal portion of the esophagus.Citation6 Presence of Barrett’s esophagus defines increased cancer risk and may be managed by surveillance or, in cases of increased cancer risk (dysplasia), by elimination of Barrett’s esophagus tissue by endoscopic radiofrequency ablation (±endoscopic mucosal resection).Citation6 Furthermore, esophageal manometry and reflux monitoring characterize reflux, that causes symptoms, ie, aggravates COPD and LPR.Citation5,Citation6 In summary, the orchestration of diagnostic findings offers the path for a tailored therapy, ie, medical, nutrition or, in cases of advanced GERD, resolution of reflux by laparoscopic anti reflux surgery.Citation5,Citation6 Going in line with the considerations of Jung et alCitation1 we think that LPR-positive COPD patients should be offered the above algorithm to attenuate the progression of the disease and the need for cortisone therapy.Citation2,Citation4 We kindly ask the authors to address the above suggestions.
Disclosure
The authors report no conflicts of interest in this communication.
References
- JungYHLeeDYKimDWClinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary diseaseInt J Chron Obstruct Pulmon Dis2015101343135126203240
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- PrombergerRSpitzerAOttJQuality of life in type 2 diabetics with gastroesophageal reflux disease: a case control studyEur Surg201345194199
- SubramanianCRTriadafilopoulosGRadiofrequency-based treatments for esophageal diseaseEur Surg2014461220