Gastro-oesophageal reflux disease and asthma: would be possible to improve therapy on the basis of what is now known?

Gastro-oesophageal reflux disease (GORD) is a chronic and relapsing clinical condition, associated or not to histopathologic alteration resulting from repeated contact of oesophageal mucosa with gastric content. This condition occurs with high prevalence in the general population and represents one of the most frequent reasons for health care-seeking addressed to primary care physician and gastroenterologists. A plethora of extra-oesophageal manifestations have been described in patients suffering from GORD and a causal relationship has been postulated by many investigators. A large cohort of studies has focused on the possible cause-effect interaction between GORD and asthma. However, despite the improvement in both asthma symptoms and medication requirements after anti-secretory therapy, no change in pulmonary function is evident. Furthermore, the pathogenetic mechanism, a vagally mediated reflex, microaspiration or increasing reactivity to the stimuli, is yet unclear. Since conflicting conclusions and the failure to find a causal relationship are generally due to the heterogeneity of the studies, further research is needed to clarify the role of GORD in asthma pathogenesis, or viceversa, and whether a medical or surgical anti-secretory treatment may be an approach to curing the asthma patients non-responders to the classical therapy.