Choroba refluksowa przełyku a astma oskrzelowa

• Authors: Iwona Patyk , Andrzej Chciałowski

Title variants

EN

Gastro-oesophageal reflux disease and bronchial asthma

• Languages of publication: EN PL

Abstracts

EN

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.

PL

Astma oskrzelowa i choroba refluksowa przełyku są często współwystępującymi jednostkami chorobowymi. Uważa się, że refluks stanowi potencjalny czynnik wywołujący lub zaostrzający astmę. Hipoteza ta opiera się zarówno na przesłankach patofizjologicznych, jak i badaniach klinicznych. W badaniach eksperymentalnych wykazano, że zakwaszanie dolnej części przełyku powoduje wzmożoną reaktywność oskrzeli. Powstało kilka teorii wyjaśniających to zjawisko, do najistotniejszych należą teoria nerwowa, zapalna i mikroaspiracji. Wykazano również, że nieswoiste testy nadreaktywności oskrzeli mogą indukować epizody refluksu, co przemawia za udziałem samej astmy w promowaniu GERD. Do osłabienia mechanizmów antyrefluksowych prowadzą związane z zaostrzeniami astmy wzrost ujemnego ciśnienia w klatce piersiowej oraz „pułapka powietrzna”, a także niektóre doustne leki rozszerzające oskrzela, zwłaszcza teofilina. Obie choroby mogą oddziaływać na siebie na zasadzie błędnego koła, co pociąga za sobą implikacje terapeutyczne. Nie ma jednak jednoznacznych danych z badań randomizowanych o skuteczności antyrefluksowej terapii farmakologicznej i chirurgicznej. Najnowsze dane z piśmiennictwa nie potwierdzają pozytywnych rezultatów takiej terapii w grupie astmy trudnej, w której dotąd rekomendowano wdrożenie leczenia dużymi dawkami IPP. Nadal brak jest przekonywających danych dotyczących roli niekwaśnego i/lub żółciowego refluksu w astmie. Konieczne jest udoskonalenie i standaryzacja metod diagnostycznych oraz protokołów terapeutycznych pozwalających wyodrębnić grupę pacjentów, u których terapia antyrefluksowa przyniesie najlepsze efekty dla kontroli astmy.

Keywords

EN

anti-reflux therapy; asthma; astma; bronchial hyperreactivity; extra-oesophageal manifestation; gastro-oesophageal reflux; nadreaktywność oskrzeli; objawy pozaprzełykowe; refluks żołądkowo-przełykowy; terapia antyrefluksowa

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Pediatria i Medycyna Rodzinna
• Year: 2009
• Volume: 5
• Issue: 2
• Pages: 102-107

Contributors

author

Iwona Patyk

• Oddział Pneumonologiczny, 10. Wojskowy Szpital Kliniczny w Bydgoszczy

author

Andrzej Chciałowski

• Wojskowy Instytut Medyczny w Warszawie

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• Document Type: article