Am. J. Respir. Crit. Care Med., Volume 157, Number 4, April 1998, 1058-1062

The Effects of Acid Perfusion of the Esophagus on Ventilation and Respiratory Sensation

STEPHEN K. FIELD, JOHN A. EVANS, and LORNE M. PRICE

Department of Medicine, Foothills Hospital and University of Calgary, Calgary, Alberta, Canada

The relationship between gastroesophageal reflux (GER) and asthma remains controversial. Asthma symptoms worsen with GER, but are not consistently related to changes in lung function. The purpose of this study was to determine whether acid perfusion (AP) of the esophagus alters ventilation and causes respiratory symptoms. Nonasthmatic patients with normal lung function and esophageal disease (16 females and nine males, FEV₁ %predicted = 99 ± 9.6), underwent a Bernstein test after motility testing. Airflow, rib cage (Vrc), and abdominal (Vab) tidal volumes, esophageal (Pes) and gastric (Pga) pressure, and surface (Es) and esophageal (Edi) diaphragm electromyographic (EMG) signals were measured. Throat, swallowing, chest, and stomach discomfort and respiratory sensation were estimated with the Borg scale. Minute ventilation ( E) increased during AP and declined during recovery with saline perfusion of the esophagus (7.1 ± 1.5 to 8.5 ± 2.4 to 7.3 ± 2.1 L/min; n = 25; p = 0.0002). Respiratory rate (RR) went from 13.6 ± 2.6 to 15.8 ± 3.4 to 15.3 ± 3.1 breaths/min (n = 25; p = 0.0002) during AP. E was greater in the Bernstein-positive patients during AP. Tidal volume (VT), Vrc, Vab, Pes, Pga, Es, and Edi did not change during AP. Chest discomfort (D) correlated with ventilation ( E = 0.7 + 0.8 D; r = 0.67; p < 0.001) and respiratory effort sensation (B) (B = 0.2 + 0.4  E; r = 0.70; p < 0.001) during AP. AP did not inhibit diaphragm activity. Increased E may explain the paradox of GER worsening respiratory symptoms without changing lung function.

This article has been cited by other articles:

				K Terada, S Muro, S Sato, T Ohara, A Haruna, S Marumo, D Kinose, E Ogawa, Y Hoshino, A Niimi, et al. Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation Thorax, November 1, 2008; 63(11): 951 - 955. [Abstract] [Full Text] [PDF]

				N. Flook, R. Jones, and N. Vakil Approach to gastroesophageal reflux disease in primary care: Putting the Montreal definition into practice Can Fam Physician, May 1, 2008; 54(5): 701 - 705. [Abstract] [Full Text] [PDF]

				H. Nordenstedt, M. Nilsson, S. Johansson, M.-A. Wallander, R. Johnsen, K. Hveem, and J. Lagergren The relation between gastroesophageal reflux and respiratory symptoms in a population-based study: the nord-trondelag health survey. Chest, April 1, 2006; 129(4): 1051 - 1056. [Abstract] [Full Text] [PDF]

				C. Casanova, J.S. Baudet, M. del Valle Velasco, J.M. Martin, A. Aguirre-Jaime, J. Pablo de Torres, and B.R. Celli Increased gastro-oesophageal reflux disease in patients with severe COPD Eur. Respir. J., June 1, 2004; 23(6): 841 - 845. [Abstract] [Full Text] [PDF]

				S. K. Field, G. A. J. Gelfand, and S. D. McFadden The Effects of Antireflux Surgery on Asthmatics With Gastroesophageal Reflux Chest, September 1, 1999; 116(3): 766 - 774. [Abstract] [Full Text] [PDF]

				S. K. Field Gastroesophageal Reflux and Respiratory Symptoms Chest, September 1, 1999; 116(3): 843 - 843. [Full Text] [PDF]

				S. K. Field A Critical Review of the Studies of the Effects of Simulated or Real Gastroesophageal Reflux on Pulmonary Function in Asthmatic Adults Chest, March 1, 1999; 115(3): 848 - 856. [Abstract] [Full Text] [PDF]