Evaluation of the intraoesophageal pH patterns in patients with bronchial hyperreactivity (BHR)

Abstract

Aims: Gastroesophageal reflux (GER) is considered a significant pathogenetical factor in the development of BHR. The aim of the study was to evaluate the intraoesophageal pH patterns in patients with BHR. Patients and methods: 43 consecutive patients (M/F 12/31) with recent diagnosis of BHR were prospectively studied. 20 patients with chronic cough, but without BHR were evaluated as controls. Patients were all submitted to reflux symptom analysis, upper gastrointestinal endoscopy, oesophageal manometry, and Bernstein-test. Proximal GER reflux was established by double channel intraoesophageal pH monitoring. The presence of oesophago-bronchial reflux (OBR) was studied by combined oesophageal acid (0.1N HCl) perfusion and metacholine test. Results: The studied patient groups had similar age, BMI, male-female ratio and were identical regarding their smoking habits. The prevalence of reflux and respiratory symptoms, the baseline lung function, the manometric parameters, the acid sensitivity and the endoscopic appearance of the oesophagus were not different. The double channel pH monitoring showed that patients with BHR had significantly more proximal acid reflux, than controls. On the contrary, similar pH patterns were observed in the distal oesophagus. The patient group with BHR was subdivided on the basis of the presence of OBR. Patients with OBR positivity were more likely to have an acid sensitive oesophagus and had more acid reflux – especially in the supine period – at the distal measurement point. Other studied parameters were not different. Conclusions: Proximal acid reflux may have a greater role in the development of BHR, than in chronic cough. The increased amount of supine acid reflux in patients with OBR positivity may indicate, that the effectiveness of the night time acid suppressive therapy can be important for the attenuation of the reflux to achieve clinical improvement.