ESOPHAGEAL DYSMOTILITY AND GASTROESOPHAGEAL REFLUX IN INTRINSIC ASTHMA

This study was undertaken to determine the prevalence of esophageal mo tor abnormalities, the incidence of gastroesophageal reflux, and the c oexistence of gastroesophageal reflux with esophageal dysmotility in p atients with intrinsic asthma. Based on clinical criteria, 34 consecut ive asthmatics, 15 patients with gastroesophageal reflux, and 10 subje cts with upper gastrointestinal symptoms with normal results of esopha geal manometry and 24-hr esophageal pH test (controls) were studied. E sophageal motor disorders were noted in 23 of 34 asthmatics, and in 10 of 15 patients with acid reflux but in none of the subjects of the co ntrol group. A positive result of the prolonged esophageal pH study (p H in the distal esophagus less than 4 for more than 4.2% of the record ing time) was obtained in 14 of 17 patients with asthma (only 17 of th e original patients were tested because the others did not give inform ed consence for this test) and in all patients with gastroesophageal r eflux. None of the members of the control group had positive test resu lts. The findings of this study show that: (1) it is possible to ident ify a group of subjects with nonallergic asthma presenting with esopha geal dysmotility, (2) the 24-hr esophageal pH study must be properly d one in such patients; (3) esophageal motor abnormalities are often ass ociated with positive pH results; and (4) more reflux was observed whi le in a supine position (especially during the night) than that observ ed either in control or reflux patients, Based on these results, patie nts with intrinsic asthma with reflux can benefit from both acid suppr essive and prokinetic drugs with notable clinical implications regardi ng standard treatment for asthma, and those with prevalent supine comp ared to upright reflux could even benefit from surgery.