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ORIGINAL ARTICLES  ASTHMA


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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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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