Proximal and distal gastro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis

Authors

  • Annemarie L. Lee,

    Corresponding author
    1. Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
    2. Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
    • Correspondence: Annemarie L. Lee, Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Vic. 3010, Australia. Email: annlee@unimelb.edu.au

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  • Brenda M. Button,

    1. Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
    2. Department of Medicine, Monash University, Melbourne, Victoria, Australia
    3. Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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  • Linda Denehy,

    1. Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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  • Stuart J. Roberts,

    1. Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia
    2. Department of Medicine, Monash University, Melbourne, Victoria, Australia
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  • Tiffany L. Bamford,

    1. Department of Medicine, Monash University, Melbourne, Victoria, Australia
    2. Janssen, Pharmaceutical Companies of Johnson and Johnson, Melbourne, Victoria, Australia
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  • Samantha J. Ellis,

    1. Department of Radiology, The Alfred, Melbourne, Victoria, Australia
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  • Fi-Tjen Mu,

    1. Department of Immunology, Monash University, Melbourne, Victoria, Australia
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  • Ralf G. Heine,

    1. Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
    2. Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Robert G. Stirling,

    1. Department of Medicine, Monash University, Melbourne, Victoria, Australia
    2. Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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  • John W. Wilson

    1. Department of Medicine, Monash University, Melbourne, Victoria, Australia
    2. Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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  • (Associate Editor: Robert Young).

Abstract

Background and objective

The aims of this observational study were (i) to examine the prevalence of symptomatic and clinically silent proximal and distal gastro-oesophageal reflux (GOR) in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis, (ii) the presence of gastric aspiration, and (iii) to explore the possible clinical significance of this comorbidity in these conditions.

Methods

Twenty-seven participants with COPD, 27 with bronchiectasis and 17 control subjects completed reflux symptom evaluation and dual-channel 24 h oesophageal pH monitoring. In those with lung disease, pepsin levels in sputum samples were measured using enzyme-linked immunosorbent assay, with disease severity (lung function and high-resolution computed tomography) also measured.

Results

The prevalence of GOR in COPD was 37%, in bronchiectasis was 40% and in control subjects was 18% (P = 0.005). Of those diagnosed with GOR, clinically silent reflux was detected in 20% of participants with COPD and 42% with bronchiectasis. While pepsin was found in 33% of COPD and 26% of bronchiectasis participants, the presence of pepsin in sputum was not related to a diagnosis of GOR based on oesophageal pH monitoring in either condition. Neither a diagnosis of GOR nor the presence of pepsin was associated with increased severity of lung disease in COPD or bronchiectasis.

Conclusions

The prevalence of GOR in COPD or bronchiectasis is twice that of the control population, and the diagnosis could not be based on symptoms alone. Pepsin was detected in sputum in COPD and bronchiectasis, suggesting a possible role of pulmonary aspiration, which requires further exploration.

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