Pulmonary manifestations of gastroesophageal reflux disease

ABSTRACT

Introduction

Gastroesophageal reflux disease (GERD) is a widespread condition with a significant impact on the quality of life and healthcare resources. In addition to its gastrointestinal problems, GERD has been linked to a variety of respiratory diseases either as a direct cause, or as a risk factor to the inability to control or worsening of the disease.

Areas covered

We performed a literature search in the PubMed database for articles addressing GERD and pulmonary diseases. This review will discuss several different pulmonary diseases affected by GERD ranging from upper airway including chronic cough, vocal cord dysfunction, lower airway diseases including COPD, asthma, and bronchiolitis obliterans syndrome to parenchymal diseases such as interstitial lung diseases. The review will discuss several different pulmonary manifestations of GERD and their contribution to patient mortality and morbidity. It will also review the mechanisms leading to these diseases, diagnostic workup, and the role of the available treatment options.

Expert opinion

GERD is often overlooked as a cause of respiratory symptoms and illnesses. The literature is sparse on the relation between GERD and respiratory diseases such as interstitial lung diseases and bronchiolitis obliterans including its role in pathogenesis, mechanisms of lung injury, and whether treatment of GERD is effective in managing such illnesses.

KEYWORDS:

• Gastroesophageal reflux disease
• asthma
• chronic cough

Article highlights

• Respiratory diseases associated with GERD develop as a result of reflex neural mechanisms caused by reflex events limited to lower esophageal sphincter or due to direct effect from the gastric content causing upper airway irritation and lung disease if aspirated

• The spectrum of respiratory diseases associated with GERD spans from upper airways to lower airways and parenchymal lung disease

• GERD may lead to chronic cough, vocal cord dysfunction, and sleep disturbances. Management of these conditions includes ruling out other causes, anti-reflux therapy, and standard measures for treatment of these illnesses.

• - GERD is commonly seen in patients with asthma and may be a cause of difficult-to-treat asthma. Treatment with proton pump inhibitors is recommended.

• GERD has been associated with increased morbidity in lung transplant patients through reflux, aspiration, immunomodulation, and allograft injury, functional decline, and rejection

• Patients with post-transplant BOS and GERD should be treated with medications to reduce gastric acidity. Refractory cases should be considered for anti-reflux surgery.

• GERD has been proposed as a contributing factor in the pathogenesis of ILD especially IPF and scleroderma. Microaspiration over time can lead to pneumonitis, increased epithelial permeability, stimulation of fibrotic proliferation, and eventual lung fibrosis.

• The role of anti-GERD therapy in patients with IPF and no documented reflux is controversial.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.