Show Summary Details
Page of

Gastroesophageal Reflux: Comorbid and Coexisting 

Gastroesophageal Reflux: Comorbid and Coexisting
Chapter:
Gastroesophageal Reflux: Comorbid and Coexisting
Author(s):

Promila Banerjee

and Stephen J. Sontag

DOI:
10.1093/med/9780199918065.003.0023
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 24 June 2021

Most asthmatic patients have gastroesophageal reflux (GER), and the evidence is strong that GER plays an important role in some patients with asthma. Despite sophisticated study methods and technologically advanced diagnostic tests, the results of published studies on mechanisms fail to provide a diagnostic test with a degree of certainty great enough to identify which patients have GER-induced or GER-exacerbated asthma and which patients will respond to antireflux therapy. Indeed, even positive results on such direct tests as sputum inspection and scintigraphic monitoring, both of which establish reflux into the tracheobronchial tree, do not necessarily establish cause or effect and cannot be used to predict outcomes. The popular and frequently used ambulatory esophageal pH test (Bravo), believed by many to be the best GER test available, can only suggest, but not prove, the diagnosis of GER-induced asthma, and pH testing cannot be safely relied on to make our clinical decisions. Despite extensive research on mechanisms of GER-induced pulmonary symptoms, we are still forced to fall back on “the therapeutic trial”—a trial of a proton pump inhibitor (PPI) to assess whether asthma improves subjectively and objectively. A good PPI response may not necessarily predict a good surgery response, and a poor response to PPI does not necessarily predict a poor response to antireflux surgery.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.