Gastroesophageal reflux disease and asthma: an intriguing dilemma

BACKGROUND: Gastroesophageal reflux disease (GORD) is characterized by typical reflux symptoms and multiple atypical extraesophageal symptoms. Gastric asthma is a prominent extraesophageal manifestation of GORD. There is persistent debate about the pathophysiologic mechanisms triggering asthma by GOR. METHODS: We conducted a review of the literature. RESULTS: The pathogenic mechanism could be either a vagally transmitted reflex or an intratracheal aspiration of refluxed material. In both hypotheses, the role of inflammatory mediators has been proposed. CONCLUSIONS: Neurogenic inflammation is a good theoretic basis for a pathogenic interpretation of the disorder. In atopic patients, food allergy has been recently proposed as a possible cause of GOR and associated respiratory symptoms, and it should be considered in the diagnostic work-up of all patients with GORD.