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Gastroesophageal Reflux: Comorbid and Coexisting 

Gastroesophageal Reflux: Comorbid and Coexisting
Gastroesophageal Reflux: Comorbid and Coexisting

Promila Banerjee

and Stephen J. Sontag

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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.

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