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A Journal on Internal Medicine

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Panminerva Medica 2004 June;46(2):135-40

language: English

Gastro-oesophageal reflux disease and asthma: would be possible to improve therapy on the basis of what is now known?

Pellicano R. 1, Ponzetto A. 1,2, Smedile A. 1,2, Repici A. 1, Rizzetto M. 1,2

1 Department of Gastro-Hepatology Molinette Hospital, Turin, Italy
2 Department of Internal Medicine University of Turin, Turin, Italy


Gastro-oesoph­a­geal ­reflux dis­ease (­GORD) is a chron­ic and relaps­ing clin­i­cal con­di­tion, asso­ciat­ed or not to his­to­path­o­log­ic alter­a­tion result­ing ­from repeat­ed con­tact of oesoph­a­geal muco­sa ­with gas­tric con­tent. This con­di­tion ­occurs ­with ­high prev­a­lence in the gen­er­al pop­u­la­tion and rep­re­sents one of the ­most fre­quent rea­sons for ­health ­care-seek­ing ­addressed to pri­mary ­care phy­si­cian and gas­troen­te­rol­o­gists. A pleth­o­ra of ­extra-oesoph­a­geal man­i­fes­ta­tions ­have ­been ­described in ­patients suf­fer­ing ­from ­GORD and a cau­sal rela­tion­ship has ­been pos­tu­lat­ed by ­many inves­ti­ga­tors. A ­large ­cohort of stud­ies has ­focused on the pos­sible ­cause-­effect inter­ac­tion ­between ­GORD and asth­ma. However, ­despite the improve­ment in ­both asth­ma symp­toms and med­i­ca­tion require­ments ­after ­anti-secre­to­ry ther­a­py, no ­change in pul­mo­nary func­tion is evi­dent. Furthermore, the pathog­e­net­ic mech­a­nism, a vagal­ly medi­at­ed ­reflex, micro­as­pi­ra­tion or increas­ing reac­tiv­ity to the stim­u­li, is yet ­unclear. Since con­flict­ing con­clu­sions and the fail­ure to ­find a cau­sal rela­tion­ship are gen­er­al­ly due to the het­ero­ge­ne­ity of the stud­ies, fur­ther ­research is need­ed to clar­i­fy the ­role of ­GORD in asth­ma path­o­gen­e­sis, or vice­ver­sa, and wheth­er a med­i­cal or sur­gi­cal ­anti-secre­to­ry treat­ment may be an ­approach to cur­ing the asth­ma ­patients non-respond­ers to the clas­si­cal ther­a­py.

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