Asthma and gastroesophageal reflux: Fundoplication decreases need for systemic corticosteroids

An association between gastroesophageal reflux (GER) and asthma has been su ggested for many decades. Although antireflux therapy (medical and surgical ) has been shown to be beneficial in patients with asthma, response to ther apy has not been well quantified. The aim of this study was to evaluate lon g-term outcome in patients with asthma and associated GER undergoing fundop lication. From a database of more than 600 patients with GER treated surgic ally between 1991 and 1996, 39 patients with asthma as their primary indica tion for surgery were identified. Asthma symptom scores were determined usi ng the National Asthma Education Program classification, and medication fre quency scores were determined preoperatively and at latest follow-up (media n follow-up 2.7 years). Comparisons were made using the Wilcoxon rank-sum t est, Asthma symptom scores decreased significantly after antireflux surgery . More important, the medication scores for use of systemic corticosteroids decreased significantly postoperatively (2.2 preoperatively vs. 0.7 postop eratively; P = 0.0001). Of the nine patients who required daily oral cortic osteroids, seven have discontinued treatment entirely (78%). In patients wi th asthma associated with GER, symptoms of asthma are improved following fu ndoplication. Especially important has been the ability to wean patients fr om systemic corticosteroids postoperatively: Fundoplication should be offer ed to those patients with GER-associated asthma, especially those who are s teroid dependent.