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Effects of Bronchial Obstruction on Lower Esophageal Sphincter Motility and Gastroesophageal Reflux in Patients with Asthma

Service d'Hépato-gastroentérologie, Hôpital Saint-André, Bordeaux; Service des Maladies Respiratoires, Hôpital du Haut-Lévêque, Pessac; INSERM U 539, CHU Hôtel Dieu, Nantes; and INSERM E9937, Université Victor Segalen Bordeaux 2, Bordeaux, France

Correspondence and requests for reprints should be addressed to Frank Zerbib, M.D., Ph.D., Service d'Hépato-gastroentérologie, Hôpital Saint-André, F-33075 Bordeaux Cédex, France. E-mail: frank.zerbib{at}chu-bordeaux.fr

The relationship between gastroesophageal reflux and asthma remains unclear. The aim of this study was to analyze the effect of bronchial obstruction on lower esophageal sphincter (LES) motility and reflux in patients with asthma. LES motility and esophageal pH were assessed in eight subjects with intermittent asthma and eight healthy volunteers during three consecutive 30-minute periods: baseline, methacholine-induced bronchospasm, and after inhalation of the ß2-agonist salbutamol. Healthy subjects inhaled 2 mg of methacholine, whereas subjects with asthma inhaled the dose of methacholine causing a 15% fall in FEV₁, as determined by a previous methacholine challenge. LES motility, esophageal pH, and FEV₁ were not significantly different between the three periods in healthy subjects. In patients with asthma, methacholine induced a 21.9 ± 2.6% decrease in FEV₁ and a concomitant increase in the rate of transient LES relaxation (TLESR) and reflux episodes. Inhalation of salbutamol decreased the rate of TLESRs but not the number of reflux episodes. We conclude that in patients with asthma, methacholine-induced bronchospasm increases the rate of TLESR and the number of reflux episodes. These results support the belief that, in asthma, bronchial obstruction may be responsible for reflux or may aggravate reflux through a mechanism that remains to be further clarified.

Key Words: asthma • gastroesophageal reflux • lower esophageal sphincter • bronchoconstriction • manometry

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