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EUROPEAN RESPIRATORY REVIEW, 2009;18: 233-243. doi:10.1183/09059180.00002509
© 2009 the European Respiratory Society
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Gastro-oesophageal reflux disease and non-asthma lung disease

R. S. Morehead

CORRESPONDENCE: R. S. Morehead, Division of Pulmonary and Critical Care Medicine, L-543 Kentucky Clinic, Lexington, KY, 40536-0284, USA. E-mail: smore2{at}email.uky.edu

Received: April 17, 2009
Accepted May 3, 2009

ABSTRACT

Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection.

Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures.

Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail.

Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

KEYWORDS: Aspiration, bronchiolitis, fundoplication, gastro-oesophageal reflux disease, idiopathic pulmonary fibrosis






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