Asymptomatic Gastroesophageal Reflux Disease Research Articles

Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy

Background. GastroEsophageal Reflux Disease (GERD) is a common problem among obese and overweight people, including as a complication of bariatric surgery, Laparoscopic Sleeve Gastrectomy (LSG). Aim. To conduct a retrospective analysis of the frequency of GERD in patients with morbid obesity after laparoscopic sleeve gastrectomy. Materials and Methods. In this retrospective study, data from 152 patients who underwent LSG were analyzed. All patients were diagnosed with morbid obesity and were deemed suitable for surgery. The minimum follow-up period was twelve months. All patients were assessed preoperatively for the severity of GERD using 24-hour pH monitoring, and upper gastrointestinal tract examination via FibroGastroDuodenoScopy (FGDS) to identify signs of reflux disease, esophagitis and Barrett's esophagus and GERD-HRQL (Health-Related Quality of Life) questionnaire. Results. During the study, out of 152 patients without GERD (DeMeester Index (DMI) was 6.87±3.38), 23 (15.1%) of them within 12 months after LSG developed de novo GERD (DMI 9.12±8.87, p=0.04). In four patients with de novo GERD, esophagitis grade A was detected. The pathomechanism of GERD following LSG was multifactorial, caused by a combination of anatomical, physiological, and physical factors. Contributing factors included the shape of the sleeve, damage to the lower esophageal sphincter, and esophageal motility disorders. Conclusions. LSG is effective in promoting weight loss, but poses a significant risk of developing GERD. Our study found a 15.1% incidence of GERD after LRH, which is lower than other studies, probably due to the routine use of 24-hour pH monitoring to identify patients with asymptomatic GERD. Anatomical changes due to LSG, in particular resection of the gastric fundus and dissection in the area of the angle of His, increase the temporary relaxation of the lower esophageal sphincter, contributing to the development of GERD. Keywords: bariatric surgery, morbid obesity, GERD.

Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy

Background. GastroEsophageal Reflux Disease (GERD) is a common problem among obese and overweight people, including as a complication of bariatric surgery, Laparoscopic Sleeve Gastrectomy (LSG). Aim. To conduct a retrospective analysis of the frequency of GERD in patients with morbid obesity after laparoscopic sleeve gastrectomy. Materials and Methods. In this retrospective study, data from 152 patients who underwent LSG were analyzed. All patients were diagnosed with morbid obesity and were deemed suitable for surgery. The minimum follow-up period was twelve months. All patients were assessed preoperatively for the severity of GERD using 24-hour pH monitoring, and upper gastrointestinal tract examination via FibroGastroDuodenoScopy (FGDS) to identify signs of reflux disease, esophagitis and Barrett's esophagus and GERD-HRQL (Health-Related Quality of Life) questionnaire. Results. During the study, out of 152 patients without GERD (DeMeester Index (DMI) was 6.87±3.38), 23 (15.1%) of them within 12 months after LSG developed de novo GERD (DMI 9.12±8.87, p=0.04). In four patients with de novo GERD, esophagitis grade A was detected. The pathomechanism of GERD following LSG was multifactorial, caused by a combination of anatomical, physiological, and physical factors. Contributing factors included the shape of the sleeve, damage to the lower esophageal sphincter, and esophageal motility disorders. Conclusions. LSG is effective in promoting weight loss, but poses a significant risk of developing GERD. Our study found a 15.1% incidence of GERD after LRH, which is lower than other studies, probably due to the routine use of 24-hour pH monitoring to identify patients with asymptomatic GERD. Anatomical changes due to LSG, in particular resection of the gastric fundus and dissection in the area of the angle of His, increase the temporary relaxation of the lower esophageal sphincter, contributing to the development of GERD. Keywords: bariatric surgery, morbid obesity, GERD.

Gastroesophageal reflux-related Non-Rapid Eye Movement parasomnia mimicking sleep-related hypermotor epilepsy

• Asymptomatic gastroesophageal reflux disease can cause laryngospasm is sleep. • Laryngospasm related arousals can lead to NREM parasomnias in someone with disturbed N3 sleep. • Sleep related laryngospasm should be on the differential for both NREM parasomnias and SHE.

Asymptomatic Barrett’s Oesophagus-Complicated Gastroesophageal Reflux Disease at Ineffective Antisecretory Therapy

Aim. A clinical description of gastroesophageal reflux disease (GERD) complicated by Barrett’s oesophagus (BO) at inadequate antisecretory therapy and the assessment of functional tests in control of conservative treatment.Key points. A 63-yo patient with no complaints in a proton pump inhibitor (PPI) therapy was admitted for a follow-up examination for BO-complicated GERD using oesophagogastroduodenoscopy (OGDS) with biopsy, high-resolution oesophageal manometry and 24-h pH-impedance. Endoscopy revealed signs of BO (long segment C1M3), erosive reflux oesophagitis (grade B in Los Angeles classification). Non-contractile oesophagus in manometry. Antisecretory therapy was stated ineffective and subject to correction in 24-h pH-impedance.Conclusion. Asymptomatic BO-complicated GERD patients comprise a special cohort. The main challenge to prevent progression into oesophageal adenocarcinoma is an adequate personalised patient management leveraging the modern diagnostic techniques, control of antisecretory treatment and its correction a situ.

Prevalence and Determinants of Gastroesophageal Reflux Disease and the Risk Factors Among Adult Patients Attending Al-Iskan Primary Health Care Center in Makkah, 2020.

Globally, gastroesophageal reflux disease (GERD) has a potentially high prevalence, with a wide rate of variability across different populations due to inconsistency in the risk factors. Hence, a cross-sectional study was conducted using a self-administered, structured questionnaire at Al-Iskan Primary Health Care (PHC) Center to investigate the prevalence rate and associated factors in Makkah Almukarramah, the west of Saudi Arabia. The study included 339 participants. The mean age for participants was 39.5 ± 15.5 years, and the range was from 18 to 84 years. Male participants were 247 (72.9%) and females were 92 (27.1%). Participants were diagnosed with GERD on achieving a GERD questionnaire score of ≥8. In our sample, 59 (17.4%) were diagnosed with asymptomatic GERD. The represented logistic regression shows that family history of GERD, marital status (divorce), smoking, physical activity frequency, tomatoes/tomato-based foods, salty foods, acidic drinks, frequent use of analgesics, and nonsteroidal anti-inflammatory drugs (NSAIDs) consumption shows statistical significance and association (P < 0.05) with increased risk of symptomatic GERD. Conclusively, the results show that GERD is prevalent in Makkah with the presence of modifiable risk factors which can significantly affect the ascendency of the disease.

Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study.

Type 2 diabetes (T2DM) is associated with gastroesophageal reflux disease (GERD) in the general population, but the relationship between these conditions in candidates for bariatric surgery is uncertain. We compared the prevalence of GERD and the association between GERD symptoms and esophagitis among bariatric candidates with and without T2DM. Cross-sectional study of baseline data from the Oseberg study in Norway. Both groups underwent gastroduodenoscopy and completed validated questionnaires: Gastrointestinal Symptom Rating Scale and Gastroesophageal Reflux Disease Questionnaire. Participants with T2DM underwent 24-h pH-metry. A total of 124 patients with T2DM, 81 women, mean (SD) age 48.6 (9.4) years and BMI 42.3 (5.5) kg/m2, and 64 patients without T2DM, 46 women, age 43.0 (11.0) years and BMI 43.0 (5.0) kg/m2, were included. The proportions of patients reporting GERD-symptoms were low (< 29%) and did not differ significantly between groups, while the proportions of patients with esophagitis were high both in the T2DM and non-T2DM group, 58% versus 47%, p = 0.16. The majority of patients with esophagitis did not have GERD-symptoms (68-80%). Further, 55% of the patients with T2DM had pathologic acid reflux. Among these, 71% also had erosive esophagitis, whereof 67% were asymptomatic. The prevalence of GERD was similar in bariatric patients with or without T2DM, and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2DM. Accordingly, GERD may be underdiagnosed in patients not undergoing a preoperative endoscopy or acid reflux assessment. Clinical Trials.gov number NCT01778738.

Per-oral endoscopic myotomy and gastroesophageal reflux: Where do we stand after a decade of "POETRY"?

Per-oral endoscopic myotomy (POEM) was introduced nearly a decade ago. Since then, the literature on its safety and efficacy has been ever increasing. Initial studies focused solely on the feasibility and efficacy of this procedure in patients with idiopathic achalasia. Subsequent studies analyzed the incidence of gastroesophageal reflux disease (GERD) in addition to the efficacy of POEM. These studies depict a high incidence of GERD after POEM. However, vast majority of these studies lacked a comprehensive evaluation of GERD after POEM. Consequently, it is difficult to provide a true estimate of the incidence of GERD in these patients. Majority of the patients with post-POEM GERD are asymptomatic and those with symptoms usually respond well to proton pump inhibitors. However, the long-term consequences of asymptomatic GERD with increased esophageal acid exposure are not well known. These patients should probably undergo regular surveillance due to theoretical risks of complications like Barrett's esophagus and esophageal adenocarcinoma. It should be acknowledged that there is no well-controlled study to support the strategy of surveillance in this group of patients. Given the high incidence of GERD after POEM, it is time to devise minimally invasive novel strategies to prevent and manage post-POEM GERD. The current literature suggests that the technique of POEM and other factors like type of achalasia do not influence the occurrence of GERD after POEM. Therefore, the endoscopists will need to think out of the box to prevent post-POEM GERD.

Preoperative esophagogastroduodenoscopy in patients without reflux symptoms undergoing laparoscopic sleeve gastrectomy: utility or futility?

AimTo evaluate the value of esophagogastroduodenoscopy (EGD) as a preoperative investigation in individuals without symptoms of Gastro-Esophageal Reflux Disease (GERD) who will undergo laparoscopic sleeve gastrectomy (LSG).Materials and methodsAfter Institutional Review Board approval was obtained, patients scheduled for LSG were prospectively enrolled in the study between January 2016 and March 2018. Patients with symptoms of GERD were excluded from the study. Participants were randomly allocated to two groups: individuals who underwent EGD before the surgery as a usual routine investigation (Group A), and individuals who were scheduled without preoperative EGD (Group B). Patient demographics, endoscopic findings, endoscopic biopsy results, and histopathological findings of the resected parts of the stomach after LSG were analyzed and recorded. Additionally, operative characteristics and outcomes, and follow up findings were recorded and analyzed with appropriate statistical methods.ResultsA total of 219 individuals without symptoms of GERD underwent LSG were enrolled. Group A included 111 individuals (25 males and 86 females). Group B comprised 108 individuals (20 males and 88 females). The mean age and mean Body Mass Index (BMI) were similar in both groups. From Group A, 86 out of 111 individuals (77.5%) had no pathology identified on EGD, while 21 individuals (18.9%) were found to have areas of gastric erythema and biopsies showed active gastritis. All LSG operations were performed without any major complication. After one year, all individuals were assessed for the presence of symptomatic GERD and no significant difference was found between the two groups.ConclusionPreoperative EGD may not be mandatory for asymptomatic GERD individuals undergoing LSG as post-operative complications and early follow up for GERD symptoms are not significantly different. Further prospective studies with longer follow up are needed to evaluate the role of EGD in individuals undergoing LSG.

A New Algorithm to Reduce the Incidence of Gastroesophageal Reflux Symptoms after Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is one of the most prefered treatment option for morbid obesity. However, the effects of LSG on gastroesophageal reflux disease (GERD) are controversial. Asymptomatic GERD and hiatal hernia (HH) is common in obese patients. Therefore, it is important to identify the high risk patients prior to surgery. This study aims to evaluate efficacy of cruroplasty for HH during LSG in morbidly obese patients using ambulatory pH monitoring (APM) results, and to investigate the patients' selection criteria for this procedure. This retrospective study includes outcomes of 59 patients who underwent LSG and HH repair according to our patient selection algorithm. Outcomes included preoperative GERD Health-Related Quality of Life (GERD-HRQL) questionnaire, APM results, percentage of postoperative excess weight loss, and total weight loss. For a total of 402 patients, APM was applied in 70 patients who had a positive score of GERD-HRQL, and 59 patients underwent LSG and concomitant HH repair who had a DeMeester score of 14.7% or above. There was no statistically significant difference in weight loss at 6 and 12-month follow-up. Two patients (3.3%) had symptoms of GERD at 12months postoperatively, and only one (1.6%) patient required treatment of proton pump inhibitor for reflux. In the total cohort, 11 (2.7%) patients also evolved de novo GERD symptoms. This study confirm that careful attention to patient selection and surgical technique can reduce the symptoms of GERD at short-term. Routine bilateral crus exploration could be a major risk factor of postoperative GERD.

Endoscopic prevalence of different grades of gastroesophageal reflux in adult asthmatics with or without reflux symptoms

Gastroesophageal reflux and asthma often coexist in the same patient. Persons with asthma are particularly prone to asymptomatic gastroesophageal reflux disease (GERD). Esophageal pH-probe studies have documented that 32–84% of the asthmatics have abnormal acid reflux. The endoscopic assessment of esophageal mucosal changes in patients with reflux symptoms is important to diagnose patients with various degrees of severity. The aim of the study was to detect the prevalence of different grades of GERD in adult asthmatics with or without GERD symptoms by using upper gastrointestinal endoscopy. This study included 50 adult patients with different levels of asthma control according to the Asthma Control Test scoring system. Patients were classified into two groups (symptomatic and less symptomatic) according to the GERD questionnaire. All patients were blindly subjected to upper gastrointestinal endoscopy. Endoscopic grading was carried out using the Los Angeles grading system for GERD. GERD was endoscopically detected in 36 patients out of 50 (72%); most of them presented with grade B gastroesophageal reflux (28%). No significant difference was observed in GERD prevalence related to the level of asthma control (P=0.98). No significant difference was observed in endoscopic GERD prevalence between symptomatic and less symptomatic groups (P=0.53). GERD with variable grades is prevalent endoscopically among adult asthmatics at all levels of asthma control with no difference between symptomatic and less symptomatic groups.

Tu1105 Gastric Acid Output Suppression in Response to Proton Pump Inhibitor Therapy in Symptomatic Versus Asymptomatic GERD Patients: Results of a Prospective Study Measuring Control and Meal-Stimulated Gastric Acid Secretion

Background: Gastro-esophageal reflux disease (GERD) is a common acid-related disorder affecting 10-20% of people. GERD is often under-investigated and over-treated, especially in refractory cases. Symptoms are used to guide management despite data showing many acid reflux events are asymptomatic, and many symptomatic events are unrelated to acid reflux. Proton pump inhibitors (PPIs) effectively treat GERD, but are often over-prescribed as non-invasive, accurate methods to measure gastric acid output (GAO) and guide PPI therapy are lacking. Such data might enhance management of patients who remain symptomatic despite appropriate PPI therapy. Recently, a new method for measuring meal-stimulated GAO using a wireless pH-sensing capsule, SmartPill (SP), was validated (Weinstein et al. Aliment Pharmacol Ther 2013). Aim: To evaluate the control and stimulated GAO of GERD patients who are symptomatic (SX) vs. asymptomatic (ASX) on PPI therapy, using traditional aspiration methods and SP, respectively. Methods: A prospective, single center study of symptoms and GAO response to PPI therapy was conducted in non-erosive GERD patients with typical GERD symptoms. GERD symptoms, duration (months) and PPI use were historically recorded. Fasting serum gastrin (pg/mL) was determined. Patients withGI surgery, motility disorders, or H. pylori infection were excluded. Control acid output (CAO; mEq/ hr) was determined by titration of gastric secretions collected by nasogastric tube or EGD just prior to the next PPI dose. Fasting patients ingested a SP, followed by Ensure Plus (240 ml) (EP) diluted to either 1⁄2 or 1⁄4 strength. Meal stimulated acid output, (SP GAO (mEq/ hr)) was calculated from the time to acidify the EP meal from pH 5 to 2. Gastric emptying time (GET; minutes) was measured by SP. Results: Twenty four patients taking PPIs were enrolled; 16 had SX GERD. Mean age was similar for SX vs ASX (44.6 vs 46.1, p=0.75). SX and ASX groups did not differ in mean values for GERD duration (71.4 vs 111.4, p= 0.40), fasting gastrin (149.9 vs 157.8, p=0.90), or GET (135.3 vs 118.8, p=0.63). A nonsignificant trend toward a higher mean PPI dose was seen in SX patients (1.31 vs 1.25 X the standard dose of PPI, p=0.86). Mean CAO (2.31 vs 1.16, p=0.40) and SP GAO (28.2 vs 44.6, p=0.2) were similar in SX and ASX GERD patients. Compared to normal untreated volunteers, SP GAO was significantly lower in both SX (53 vs 28.3, p=0.0004) and ASX (53 vs 30, p=0.0095) groups. Conclusions: SX and ASX GERD patients on PPI therapy have similar CAO and SP GAO, which are significantly lower than untreated volunteers. This suggests less acid suppression is required to relieve symptoms in a subset of GERD patients, who may be less sensitive to acid reflux. Therefore, higher PPI doses may be needed to further suppress acid and relieve symptoms in unresponsive patients.

Gastroesophageal reflux disease and childhood asthma

Gastroesophageal reflux disease (GERD) is common in children with asthma and may be present with or without symptoms. Clinicians, influenced by position statements in national guidelines, have routinely treated children with poorly controlled asthma with various anti-GERD medications. This practice is based on the pervasive but unproven belief that GERD is an important determinant of poor asthma control. Clinical studies show that GERD is highly prevalent in children with asthma, with estimates as high as 80%, but nearly half of the children are asymptomatic. However, there is no conclusive evidence per se that asymptomatic GERD informs asthma control, and treatment of GERD in the few controlled trials available for review does not substantively improve asthma outcomes. In a recent large controlled clinical trial, treatment with a proton-pump inhibitor (PPI) was not only ineffective, but adverse effects were common, including an increased prevalence of symptomatic respiratory infections. Current evidence does not support the routine use of anti-GERD medications in the treatment of poorly controlled asthma of childhood. However large controlled trials of children symptomatic of both GERD and asthma have not been conducted, and in this case the benefits of treatment, although unproven, might outweigh the risks.

Silent Gastroesophageal Reflux Disease

Silent Gastroesophageal Reflux Disease

Su1054 Perception About Gastroesophageal Reflux Disease (GERD) and Its Impact on Daily Life in the General Population: Results From a Large Population Based AGA Survey

Dental erosions are increasingly recognized as a possible complication of GERD often not accompanied by classic GERD symptoms. The clinical course of silent or asymptomatic GERD in these patients, as well as the best treatment options, are unknown. Methods: Patients presenting to the Bern University Dental Clinic with advanced dental erosions (Lussi erosion index >1) without symptoms of reflux (less than once per week) and without treatment for GERD were referred for upper GI-endoscopy and 24-hour esophageal impedance pH-metry after exclusion of extrinsic and non-reflux causes of dental erosions. For analysis a pH-threshold of 4 was applied. All patients with abnormal reflux were treated with esomeprazole 40mg daily (20mg bid). Follow-up impedance pH-metry was performed annually 2 weeks after discontinuation of esomeprazole. Results: 231 successive patients (146 males, mean age and range: 34 (9-67yr) were studied. 214 patients (138 males) had increased reflux (pH 4% of the 24h measurement), with a mean time with pH<4 (95% CI) of 14% (10-18). 54 patients (25%) had esophagitis and 52 (24%) had a hiatal hernia. Follow-up pH-monitoring was possible in 88 patients for up to a mean of 3±1.8 years. The % time with pH<4 during the last 24h pH-monitoring period was 11% (8-14). Reflux had returned to normal levels in 29 patients (33%). During esomeprazole treatment further visual progression of dental erosions only occurred in 12 patients (14%). Summary and Conclusions: In patients presenting to a dental clinic with advanced dental erosions significant, silent GERD is common after exclusion of other possible causes. In most patients treated with esomeprazole 40mg daily there is no further progression of dental erosions. A spontaneous regression of reflux to normal values only occurs in a minority of patients after a mean of 3 years, necessitating long-term preventive treatment.

Clinical feature of asymptomatic reflux esophagitis in patients who underwent upper gastrointestinal endoscopy

Prevalence of gastroesophageal reflux disease (GERD) varies in regions, but few reports on clinical features and quality of life (QOL) of asymptomatic GERD exist in Japan. Endoscopy was performed in our department between April 2008 and September 2010. Among 6409 cases answering Frequency of Scale for the Symptoms of GERD (FSSG) and SF8 QOL (PCS: physical component summary; MCS: mental component summary), proton pump inhibitor or histamine 2 receptor antagonist users were excluded, and 388 cases diagnosed as reflux esophagitis (RE) (Los Angeles Classification grade A, B, C, D) were analyzed. Asymptomatic cases with FSSG total score = 0 were defined as asymptomatic RE (AsymRE) and FSSG total score ≥ 1 as symptomatic RE (SymRE). Each clinical feature was analyzed. The frequency of AsymRE was 11.6% of RE (AsymRE, n = 45; SymRE, n = 343). Patient characteristics in AsymRE, SymRE were male/female = 35/10; 239/104 (not significant), mean age (year) = 63.5 ± 14.3; 58.3 ± 12.7 (P < 0.01), body mass index = 23.9 ± 4.3; 23.5 ± 3.7 (ns), respectively. Regarding the grade of RE, grade A 80.0%, B 17.8%, C 2.2% and D 0% in AsymRE, and grade A 72.6%, B 24.8%, C 2.0% and D 0.6% in SymRE (ns). PCS in SF8 was AsymRE; SymRE = 51.8 ± 9.8; 49.0 ± 7.7 (P < 0.01) and MCS in SF8 was AsymRE; SymRE = 51.4 ± 9.4; 48.2 ± 7.6 (P < 0.01), respectively. The prevalence of asymptomatic RE was high, particularly in elderly subjects. Unlike symptomatic RE, QOL was not impaired at all with asymptomatic RE. No differences were seen between groups in clinical features such as endoscopic severity of RE, indicating that asymptomatic RE is a condition that should not be overlooked clinically.

PPIs Don't Ease Asthma Symptoms in Children with Severe Asthma and Asymptomatic GERD

Gastroesophageal reflux disease (GERD) is more common in children with asthma than in children without asthma, but whether the association is causal is

Silent gastroesophageal disease: Clinical implications of an unknown disease

Silent gastroesophageal disease: Clinical implications of an unknown disease

The relationship between gastroesophageal reflux and asthma: an update

Asthma and gastroesophageal reflux disease (GERD) are both common conditions and, hence, they often coexist. However, asthmatics have been found to have a much greater prevalence of GERD symptoms than the general population. There remains debate regarding the underlying physiologic mechanism(s) of this relationship and whether treatment of GERD actually translates into improved asthma outcomes. Based on smaller trials with somewhat conflicting results regarding improved asthma control with treatment of GERD, current guidelines recommend a trial of GERD treatment for symptomatic asthmatics even without symptoms of GERD. However, recently a large multicenter trial demonstrated that the treatment of asymptomatic GERD with proton-pump inhibitors did not improve asthma control in terms of pulmonary function, rate of asthma exacerbations, asthma-related quality of life, or asthma symptom frequency. These data suggest empiric treatment of asymptomatic GERD in asthmatics is not a useful practice. This review article provides an overview of the epidemiology and pathophysiologic relationships between asthma and GERD as well as a summary of current data regarding links between treatment of GERD with asthma outcomes.

T1694 Characteristics of Asymptomatic Gastroesophageal Reflux Disease (GERD) and Association With Lifestyle Factors – Asymptomatic GERD vs. Non-Erosive Reflux Disease (NERD)

T1694 Characteristics of Asymptomatic Gastroesophageal Reflux Disease (GERD) and Association With Lifestyle Factors – Asymptomatic GERD vs. Non-Erosive Reflux Disease (NERD)

Gastroesophageal reflux disease and asthma

Asthma and gastroesophageal reflux disease (GERD) are both common diseases, and hence they often coexist. However, the coexistence of asthma and GERD is far more frequent than chance association. There remains debate regarding the mechanism of this relationship and whether treatment of GERD improves asthma outcomes. Recent data have confirmed the high prevalence of GERD among patients with asthma. Many asthmatic patients with GERD documented by pH probe do not have classic symptoms of GERD and are considered to have 'silent GERD'. On the basis of smaller trials with somewhat conflicting results regarding improved asthma control with treatment of GERD, consensus guidelines recommend a trial of GERD treatment for symptomatic asthmatic patients even without symptoms of GERD. Recently, a large multicenter trial demonstrated that the treatment of asymptomatic GERD with proton pump inhibitors did not improve asthma control in terms of pulmonary function, rate of asthma exacerbations, asthma-related quality of life, or asthma symptom frequency. Asthmatic patients have more GERD than the general population. There is not a clear understanding of why this is true. Current guidelines recommend that physicians consider treating patients who have poorly controlled asthma for GERD, even without GERD symptoms. Recent data suggest that this is not a useful practice for mild-to-moderate asthmatic patients.