Effects of Bronchial Obstruction on Lower Esophageal Sphincter Motility and Gastroesophageal Reflux in Patients with Asthma

• Published in: American journal of respiratory and critical care medicine Vol. 166; no. 9; pp. 1206 - 1211
• Main Authors: Zerbib, Frank, Guisset, Olivier, Lamouliatte, Herve, Quinton, Andre, Galmiche, Jean Paul, Tunon-de-Lara, J. Manuel
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 01.11.2002; American Lung Association
• Subjects: Adult; Airway Obstruction - chemically induced; Airway Obstruction - complications; Airway Obstruction - physiopathology; Asthma - complications; Asthma - physiopathology; Biological and medical sciences; Bronchial Diseases - chemically induced; Bronchial Diseases - complications; Bronchial Diseases - physiopathology; Bronchoconstrictor Agents - adverse effects; Bronchoconstrictor Agents - pharmacology; Chronic obstructive pulmonary disease, asthma; Esophageal Motility Disorders - etiology; Esophageal Motility Disorders - physiopathology; Esophagogastric Junction - drug effects; Esophagogastric Junction - physiopathology; Female; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - physiopathology; Humans; Male; Medical sciences; Methacholine Chloride - adverse effects; Methacholine Chloride - pharmacology; Pneumology; Respiratory Function Tests; Risk Factors; Severity of Illness Index; Human; Manometry; Gastroesophageal reflux; Motility; Prognosis; Respiratory disease; Esophageal sphincter; Esophageal disease; Asthma; Bronchoconstriction; Lung function; Digestive diseases; Obstructive pulmonary disease
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200110-033OC

The relationship between gastroesophageal reflux and asthma remains unclear. The aim of this study was to analyze the effect of bronchial obstruction on lower esophageal sphincter (LES) motility and reflux in patients with asthma. LES motility and esophageal pH were assessed in eight subjects with intermittent asthma and eight healthy volunteers during three consecutive 30-minute periods: baseline, methacholine-induced bronchospasm, and after inhalation of the beta2-agonist salbutamol. Healthy subjects inhaled 2 mg of methacholine, whereas subjects with asthma inhaled the dose of methacholine causing a 15% fall in FEV(1), as determined by a previous methacholine challenge. LES motility, esophageal pH, and FEV(1) were not significantly different between the three periods in healthy subjects. In patients with asthma, methacholine induced a 21.9 +/- 2.6% decrease in FEV(1) and a concomitant increase in the rate of transient LES relaxation (TLESR) and reflux episodes. Inhalation of salbutamol decreased the rate of TLESRs but not the number of reflux episodes. We conclude that in patients with asthma, methacholine-induced bronchospasm increases the rate of TLESR and the number of reflux episodes. These results support the belief that, in asthma, bronchial obstruction may be responsible for reflux or may aggravate reflux through a mechanism that remains to be further clarified.