Introduction: Asthma and gastroesophageal reflux disease (GERD) have been closely linked, but the association of one with the other is not completely understood. Though GERD contributes to and exacerbates asthma symptoms, best management has not been established. Many asthmatics have subjective and objective findings of GERD, but the use of antireflux medication may not reduce reflux-related asthma symptoms at all. Better management of GERD may lead to better management of GERD-induced asthma. Outcomes presented in the review will be evaluated using GRADE to assess the quality of evidence each study provides.
Methods: Articles for this review were chosen by relevance to the search terms “asthma” and “fundoplication”. Literature containing the relevant subject terms was evaluated, and articles were chosen for inclusion if they specifically addressed patients who underwent fundoplication for the primary indication of asthma and/or respiratory symptoms due to reflux disease.
Results: The studies all showed fundoplication to be superior over antacid medication of any kind. Patients undergoing fundoplicaton showed immediate improvement and continued improvement or cure through the course of follow-up periods. Postoperatively, most patients showed reduced asthma symptoms and required fewer asthma control medications.
Conclusion: Nissen fundoplication cures acid reflux in 90 percent of GERD patients, whereas medical management has only mediocre results and those results are not usually long-lived. Even though proton pump inhibitors (PPIs) and H2 receptor antagonists (H2 blockers) reduce acid production, reflux of acid and microaspiration of refluxate still occurs. This microaspiration continues to contribute to hypersensitivity of the airways. With fundoplication, the pressure of the lower esophageal sphincter is restored and further reflux is prevented, thus making fundoplication the most effective management of GERD, and of any asthma and respiratory symptoms associated with the reflux. While fundoplication does not cure or markedly improve every asthma symptom or pulmonary function test, these studies, assessed by GRADE criteria, provide good, though not excellent, evidence that fundoplication should be considered for patients with GERD-induced asthma, especially those whose symptoms interfere with daily living or those requiring use of oral corticosteroids.
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