(Associate Editor: Robert Young).
Proximal and distal gastro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis
Article first published online: 25 DEC 2013
© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology
Volume 19, Issue 2, pages 211–217, February 2014
How to Cite
Lee, A. L., Button, B. M., Denehy, L., Roberts, S. J., Bamford, T. L., Ellis, S. J., Mu, F.-T., Heine, R. G., Stirling, R. G. and Wilson, J. W. (2014), Proximal and distal gastro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis. Respirology, 19: 211–217. doi: 10.1111/resp.12182
- Issue published online: 14 JAN 2014
- Article first published online: 25 DEC 2013
- Accepted manuscript online: 27 AUG 2013 07:10AM EST
- Manuscript Accepted: 6 AUG 2013
- Manuscript Revised: 30 JUL 2013
- Manuscript Revised: 5 JUL 2013
- Manuscript Received: 29 MAY 2013
- Physiotherapy Research Foundation
- The University of Melbourne
- Monash University
- National Health and Medical Research Council
- chronic obstructive pulmonary disease;
- gastro-oesophageal reflux;
- quality of life
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.
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.
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.
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.