P G Gibson1, R L Henry, J L Coughlan. 1. Department of Respiratory Medicine, John Hunter Hosptial, Respiratory Medicine, John Hunter Hospital, Locked Bag 1, Hunter Mail Centre, NSW, Australia, 2310. mdpgg@mail.newcastle.edu.au
Abstract
BACKGROUND: Asthma and gastro-oesophageal reflux are both common medical conditions and often co-exist. Studies have shown conflicting results concerning the effects of lower oesophageal acidification as a trigger of asthma. Furthermore, asthma might precipitate gastro-oesophageal reflux. Thus a temporal association between the two does not establish that gastro-oesophageal reflux triggers asthma. Randomised trials of a number of treatments for gastro-oesophageal reflux in asthma have been conducted, with conflicting results. OBJECTIVES: The objective of this review was to evaluate the effectiveness of treatments for gastro-oesophageal reflux in terms of their benefit on asthma. SEARCH STRATEGY: The Cochrane Airways Group trials register, review articles and reference lists of articles were searched. SELECTION CRITERIA: Randomised controlled trials of treatment for oesophageal reflux in adults and children with a diagnosis of both asthma and gastro-oesophageal reflux. DATA COLLECTION AND ANALYSIS: Trial quality and data extraction were carried out by two independent reviewers. Authors were contacted for confirmation or more data. MAIN RESULTS: Nine trials met the inclusion criteria. Interventions included proton pump inhibitors (n=3), histamine antagonists (n=5), surgery (n=1) and conservative management (n=1). Treatment duration ranged from 1 week to 6 months. A temporal association between asthma and gastro-oesophageal reflux was investigated in 4 trials and found to be present in a proportion of participants in these trials. Anti-reflux treatment did not consistently improve lung function, asthma symptoms, nocturnal asthma or the use of asthma medications. REVIEWER'S CONCLUSIONS: In asthmatic subjects with gastro-oesophageal reflux, (but who were not recruited specifically on the basis of reflux-associated respiratory symptoms), there was no overall improvement in asthma following treatment for gastro-oesophageal reflux. Subgroups of patients may gain benefit, but it appears difficult to predict responders.
BACKGROUND:Asthma and gastro-oesophageal reflux are both common medical conditions and often co-exist. Studies have shown conflicting results concerning the effects of lower oesophageal acidification as a trigger of asthma. Furthermore, asthma might precipitate gastro-oesophageal reflux. Thus a temporal association between the two does not establish that gastro-oesophageal reflux triggers asthma. Randomised trials of a number of treatments for gastro-oesophageal reflux in asthma have been conducted, with conflicting results. OBJECTIVES: The objective of this review was to evaluate the effectiveness of treatments for gastro-oesophageal reflux in terms of their benefit on asthma. SEARCH STRATEGY: The Cochrane Airways Group trials register, review articles and reference lists of articles were searched. SELECTION CRITERIA: Randomised controlled trials of treatment for oesophageal reflux in adults and children with a diagnosis of both asthma and gastro-oesophageal reflux. DATA COLLECTION AND ANALYSIS: Trial quality and data extraction were carried out by two independent reviewers. Authors were contacted for confirmation or more data. MAIN RESULTS: Nine trials met the inclusion criteria. Interventions included proton pump inhibitors (n=3), histamine antagonists (n=5), surgery (n=1) and conservative management (n=1). Treatment duration ranged from 1 week to 6 months. A temporal association between asthma and gastro-oesophageal reflux was investigated in 4 trials and found to be present in a proportion of participants in these trials. Anti-reflux treatment did not consistently improve lung function, asthma symptoms, nocturnal asthma or the use of asthma medications. REVIEWER'S CONCLUSIONS: In asthmatic subjects with gastro-oesophageal reflux, (but who were not recruited specifically on the basis of reflux-associated respiratory symptoms), there was no overall improvement in asthma following treatment for gastro-oesophageal reflux. Subgroups of patients may gain benefit, but it appears difficult to predict responders.
Authors: Beverley J Shea; Lex M Bouter; Joan Peterson; Maarten Boers; Neil Andersson; Zulma Ortiz; Tim Ramsay; Annie Bai; Vijay K Shukla; Jeremy M Grimshaw Journal: PLoS One Date: 2007-12-26 Impact factor: 3.240