Asthma and gastric reflux

[Roseane]

Posted By  HFHSM.D.-sg on February 13, 1998 at 07:29:58:

In Reply to: Asthma and gastric reflux posted by Roseanne on February 04, 1998 at 21:52:44:

: I have asthma that is aggravated by GERD.
  I've had a barium swallow,gastroscopy,ph test and Bernstein test.Everything
  was negative except for the Bernstein test.
  When I had the ph test my stomach was fine for days preceding and after the
  test so that's probably why it came back negative.
  Although the tests have come back negative my symptoms of constant belching
  ,fullness,bloating ,wheezing,throat irritation and heartburn continue
  to get worse.
  I am going for a surgical consult for a laprascopic fundoplication.I have my concerns re
  garding the accuracy of the diagnosis
  because so many of the negative test results.I tried Cisapride and Prilosec.The Losec did zilch, then I was put on Pantoloc which
  has helped but still not to the extent that I can go off my asthma drug,Accolate.
  Whenever my stomach acts up,my asthma acts up.When my stomach is good I
  don't wheeze.In fact when my Ventolin doesn't work I take Rolaids and I not
  ice a definite improvement in my breathing.My question is: Can you have a
  major reflux problem while tests are coming up negative?
  And would you do surgery based on the symptoms only?
  I also have irritable bowel symdrome.Could this be
  a IBS problem instead of reflux?

[HFHSM.D.-sg]

_
Dear Roseanne,
We have had detailed discussions regarding the information that you provided us. Since you have symptoms that are severe enough for you to consider surgery  we think that the following issues should be addressed.
“DO I HAVE GASTROESOPHAGEAL REFLUX DISEASE (GERD)?”
GERD is an extremely common symptom. It has been estimated that 10% of the population will have intermittent symptoms of reflux.  It is difficult to make a clinical diagnosis over the Internet but we can describe the classical symptoms of GERD-
1) Heartburn- described as a burning discomfort in the lower chest or in the center stomach under the ribs that can radiate to the neck ;
2) Regurgitation- described as effortless return of partially digested food or gastric juices into the mouth without nausea, retching or abdominal pain;
3) Increased production of saliva ;
4) Some people can have voice hoarseness, sore throat or increased frequency of dental cavities;
5) Dysphagia (food sticking in the chest that may be associated with pain), weight loss, anemia vomiting can be symptoms of reflux but should make your doctor consider other possible diagnoses.
Some of your symptoms are not consistent with GERD. Abdominal fullness, bloating and belching are not considered symptoms of GERD and could represent irritable bowel syndrome, as you suggest.
You have had numerous tests to evaluate your esophagus and the possibilities of acid reflux. Although these tests have some limitations, the result of all the information that you present would suggest that if you have GERD, it is presenting in an unusual fashion.“
IF I DO HAVE GERD, HAVE I DONE MAXIMAL MEDICAL THERAPY?”
Effective therapy for most patients with GERD starts with life-style modifications that include head of bed elevation, smoking cessation, dietary therapy (avoidance of fatty foods, chocolate, peppermints and excessive alcohol), weight loss, refraining from assuming a supine position immediately after meals and avoidance of meals immediately before bedtime.  Sucking hard candies or chewing gum is also recommended.
Prilosec or Cisapride are very effective drugs for treating GERD and are often prescribed in combination as you have done. It is important to take these medications in the correct dosages for the appropriate durationof time. These drugs are to be used in conjunction with life-style modification. Based on the information that you provide, we do not know if you have had maximal medical therapy.
“IS MY ASTHMA RELATED TO GERD?”
There is evidence to suggest that some asthmatics have acid reflux into the chest as the cause of their asthma. Control of the reflux problem can improve your asthma. The benefit requires that you receive maximal medical therapy. Intermittent antacids may improve your acute wheezing but would not represent a longterm answer to your problem. If there is a relation between your asthma and GERD then maximal medical therapy should produce some relief of your symptoms.
“WHAT IS THE ROLE OF SURGERY?”
Surgery is advocated for patients who have failed maximal medical therapy and have developed complications due to long-standing GERD e.g. strictures, bleeding. Recurrent flares of asthma could be considered an indication for surgery but only if there is 1) evidence of substantial reflux and 2) a correlation between the reflux and the development of asthma symptoms that are difficult to control with medications.  
Based on the information that you have provided us we are uncertain if you have documented GERD. We also do not know much about your asthma. Do you have severe asthma requiring multiple medications? Is it possible there are other triggers for your asthma? More importantly, is the diagnosis of asthma been proven and other diseases that can easily mimic asthma have been excluded?               
Finally, you should know that the results of laproscopic fundoplication are very much dependent on the on the experinece and skill of the individual surgeon. It is important for you to talk to your surgeons about their results and potential complications.
“COULD ALL THESE SYMPTOMS BE DUE TO IBS?”
Some of your symptoms such as bloating, fullness and belching could be due to IBS. Other symptoms, however, are not characteristic of IBS.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Zonca, one of our experts in the treatment of esophageal disease.
HFHSM.D.-sg
keywords esophagitis, fundoplication, irritable bowel syndrome, acid reflux
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