Gastroesophageal Reflux Disease (GERD)

Symptoms of GERD

• heartburn
  
  
• regurgitation
  
  

Other suggestive syptoms

• dysphagia
  
  
• hypersalivation
  
  
• globus sensation
  
  
• odynophagia
  
  
• nausea

Symptoms of GERD complicating asthma may include increased asthma symptoms after meals or foods that lower esophageal sphincter (LES) pressure (e.g. chocolate, peppermint, caffeine, alcohol)

Some studies estimate the 30-90% prevalence of GERD among patients with asthma but GERD likely does not complicate asthma in patients without symptoms of reflux.

Postulated mechanisms to why esophageal acid produces bronchoconstriction

There are many postulated mechanisms for the niterplay between GERD and asthma: increased vagal tone, heightened bronchial reactivity, micro-aspiration of gastric contents into the upper airway, inflammation of the upper airway leading to sensitization to cough, beta-agonists can decrease LES pressure, and prednisone increasing time esophagus is exposed to gastric acid has all been examined.

Diagnosis and management

The diagnosis for GERD Treatment responsive asthma is clinical. In patients with symptomatic GERD, consider referral to gastroenterology clinic or lifestyle modifications or trial of high dose proton pump inhibitor twice a day for 2-3 months with patient education. Recommend monitoring for both symptoms of both GERD and asthma during trial. For those with improvement in GERD but not in their asthma, recommend treatment per usual GERD guidelines. If there is no clinical response to GERD with PPI, dysphagia, odynophagia, weight loss, anemia, recommend referral to GI.