Asthma and Esophageal Disease

Many people with asthma find they have another condition as well: frequent heartburn and accompanying symptoms known as gastroesophagal reflux disease. or GERD. Medical researchers have long doubted this was a coincidence, and now a Duke University team has found evidence of a connection between the conditions.

As many as 90 percent of asthma patients have some aspect of reflux as well. What the Duke researcher found is that certain aspects of GERD affect the immune system. In particular, even miniscule amounts of gastric fluid in the lungs can make the immune system particularly sensitive to the allergens that can trigger asthma.

Miniscule amounts of gastric fluid in the lungs—called microaspirations—is a common symptom of GERD. In GERD, the ring of muscles that normally prevents the stomach contents from going back into the esophagus doesn’t form a tight seal. When this happens, gastric fluid flows backwards, irritating the esophagus and leading to heartburn and sometimes nausea, as well as microaspirations.

Alcohol seems to increase the risk of this occurring, but the evidence is not conclusive. It is widely recognized that obesity and pregnancy put pressure on the esophagus which may prevent the ring of muscles from properly closing. Smoking is also a risk factor for GERD, as are scleroderma and other connective tissue disorders. Some medications also increase the risk.

Medical treatment for GERD usually starts with antacids. These neutralize the stomach acid, but won’t heal the damage to the esophagus. The same is true of medications to reduce acid production. Medications called proton pump inhibitors do heal the damage, as well as stopping excess acid production. Pyrokinetc agents help strengthen the muscles to stop the condition from recurring.

There are also lifestyle treatments alongside or instead of a medical approach. Simply wearing loose clothing can help, as can maintaining a healthy weight. Some foods cause excess acid production; while the list varies, common culprits include fried foods, tomatoes, chocolate, mint, and caffeine. Eating smaller meals and not lying down for at least three hours afterward can help, as can elevating the head of the bed, such as with a wedge or cinder blocks. Finally, quitting smoking will help alleviate GERD and its symptoms.

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