Gastric Asthma: a Pathophysiological Entity?

BACKGROUND: Gastro-oesophageal reflux disease (GORD) is manifested by typical reflux symptoms and atypical extra-oesophageal symptoms. Important in this respect are respiratory conditions. Gastric asthma is a prominent example of these extra-oesophageal manifestations of GORD. There is, however, much debate about its prevalence, pathophysiology and clinical importance. METHODS: Narrative review of the literature. RESULTS: In asthmatics, the prevalence of GORD is generally reported to be higher than in normals, but with a wide range, probably due to patient selection. In a minority of asthmatics GORD aggravates or triggers asthma. The pathogenetic mechanisms can be a vagally transmitted reflex as well as micro-aspiration of refluxed material. The association with inflammatory mediator release has been insufficiently investigated. Selecting those who are likely to respond to anti-reflux measures is important: those with difficult to treat asthma, non-allergic asthma, adult-onset asthma with GORD. Oesophageal pH-metry to prove GORD and gastroscopy to diagnose Barrett's metaplasia are advisable.