Treatment of GERD Irrespective of Symptoms and Severity in COPD: To be or not to be!

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COPD and GERD more commonly diagnosed and frequently reported health issues due to overlapping pathophysiological mechanisms and now considered as ‘two sides of same coin’. COPD related anatomical changes and medications will alter the course of existing GERD and increase the risk of new onset GERD. Proximal and distal anatomical locations of GERD have variable presentations such as worsening of COPD, acute non-infective exacerbations, recurrent cough, and respiratory failure. Proximal pathways involve direct lung injury by means of microaspiration of gastric contents and microbiological colonization. Distal pathway involves indirect mechanisms by sharing common anatomical and embryological developments with involvement of vagus nerve mediated noradrenergic cholinergic mediator’s related effects on bronchi and bronchioles. Both proximal and distal pathways have effects on lung functions. GERD has negative impact on natural course of COPD and exists in asymptomatic and symptomatic types. Prevalence of GERD should be actively sought in all COPD cases to prevent exacerbations, decrease lung functions decline, lower the risk of clinical and physiological worsening, and overall cost of care because of these high index issues. PPI therapy has significant effects on patients with COPD in reducing the number of acute attacks, adverse reactions, and mortality. Recurrent exacerbations need GERD to be ruled out in all cases of COPD to have successful treatment outcome. Only symptomatic cases treatment has shown positive outcome in GERD with COPD. Hence, ‘to be or not to be is the real question’ and no treatment is recommended for asymptomatic GERD cases with COPD irrespective of disease severity.