Gastro-oesophageal reflux disease and bronchial asthma

Bronchial asthma and gastro-oesophageal reflux disease are often coexisting disease entities. Reflux is thought to be a potential factor stimulating or aggravating asthma. This hypothesis is based on both pathophysiological premises and clinical examinations. In an experimental study, it was indicated that the acidification of the lower part of the oesophagus causes an increase in bronchial reactivity. Several mechanisms are suggested to explain this phenomenon, of which the most essential are the nervous, inflammatory and microaspiration theories. It was also indicated that unspecific tests for bronchial hyperreactivity could induce reflux episodes, which argues for the role of asthma itself in inducing GERD. Weakening of anti-reflux mechanisms is brought about by an increase in negative pressure in the chest and the "air trap", related to exacerbations of asthma, and also by some oral bronchodilating drugs, especially theophylline. Both diseases can interact with each other on the basis of a vicious circle, which result in therapeutic implications. However, there is no explicit data from randomised studies concerning the effectiveness of pharmacological and surgical anti-reflux treatment. The latest data from the literature does not prove the positive results of such a therapy in the group of difficult asthma, in which implementation of treatment with large doses of IPP has been recommended so far. There is still no convincing data concerning the role of non-acid and/or biliary reflux in asthma. It is necessary to improve and standardise diagnostic methods and therapeutic protocols allowing us to single out a group of patients in whom the anti-reflux therapy will bring the best effects for the control of asthma.