REVIEW   

Minerva Medica 2017 August;108(4):350-6

DOI: 10.23736/S0026-4806.17.05181-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Asthma and gastroesophageal reflux disease: a multidisciplinary point of view

Paolo SOLIDORO ¹, Filippo PATRUCCO ¹ ✉, Sharmila FAGOONEE ², Rinaldo PELLICANO ³

¹ Division of Pulmonology, Cardiothoracic and Vascular Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy; ² Institute for Biostructures and Bioimages (CNR) c/o Molecular Biotechnology Center, University of Turin, Turin, Italy; ³ Unit of Gastroenterology, Molinette Hospital, Turin, Italy

Asthma and gastroesophageal reflux (GORD) are widespread and potentially coexisting diseases. Incidence and prevalence of concomitant asthma and GORD are highly variable among studies. This is mainly due to the heterogeneity of study designs. To explain a potential link, some pathophysiological anomaly has been proposed such as the altered pressure gradient between thorax and abdomen, the parasympathetic reflex, the heightened bronchial reactivity and chemical effects of microaspired gastric juice. An accurate diagnosis of asthma and GORD is pivotal in order to lead effective treatment and to reach a significant positive outcome, in terms of quality of life and respiratory function amelioration. Gastroenterological evaluation of GORD includes the empiric proton pump-inhibitors (PPIs) trial, the esophageal pH monitoring and endoscopic evaluation. Besides spirometric investigations, pulmonologist have more specific examens such as bronchoalveolar lavage and exhaled breath condensate. Actually, international recommendations regarding the management of asthma suggest the assessment of potential comorbidities, including the presence of GORD, mostly in children, only in patients with normal pulmonary functional tests with frequent respiratory symptoms, and in case of uncontrolled asthma. Symptomatic gastro-esophageal reflux patients should be treated, but those with uncontrolled asthma should not be treated with anti-reflux drugs unless they are symptomatic for reflux. This review explores the state of the art about the pathogenesis and the management of the relationship between asthma and GORD.

KEY WORDS: Asthma - Gastroesophageal reflux - Esophagitis - Respiration disorders