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A qualitative synthesis of gastro-oesophageal reflux in bronchiectasis: Current understanding and future risk

Lookup NU author(s): Dr Christopher Ward, Professor Jeffrey Pearson, Dr James Lordan, Professor Anthony De Soyza

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Abstract

© 2018 Gastro-oesophageal reflux disease (GORD) is a common comorbidity in bronchiectasis, and is often associated with poorer outcomes. The cause and effect relationship between GORD and bronchiectasis has not yet been fully elucidated and a greater understanding of the pathophysiology of the interaction and potential therapies is required. This review explores the underlying pathophysiology of GORD, its clinical presentation, risk factors, commonly applied diagnostic tools, and a detailed synthesis of original articles evaluating the prevalence of GORD, its influence on disease severity and current management strategies within the context of bronchiectasis. The prevalence of GORD in bronchiectasis ranges from 26% to 75%. Patients with co-existing bronchiectasis and GORD were found to have an increased mortality and increased bronchiectasis severity, manifest by increased symptoms, exacerbations, hospitalisations, radiological extent and chronic infection, with reduced pulmonary function and quality of life. The pathogenic role of Helicobacter pylori infection in bronchiectasis, perhaps via aspiration of gastric contents, also warrants further investigation. Our index of suspicion for GORD should remain high across the spectrum of disease severity in bronchiectasis. Identifying GORD in bronchiectasis patients may have important therapeutic and prognostic implications, although clinical trial evidence that treatment targeted at GORD can improve outcomes in bronchiectasis is currently lacking.


Publication metadata

Author(s): McDonnell MJ, O'Toole D, Ward C, Pearson JP, Lordan JL, De Soyza A, Loebinger M, Chalmers JD, Laffey JG, Rutherford RM

Publication type: Review

Publication status: Published

Journal: Respiratory Medicine

Year: 2018

Volume: 141

Pages: 132-143

Print publication date: 01/08/2018

Online publication date: 30/06/2018

Acceptance date: 29/06/2018

ISSN (print): 0954-6111

ISSN (electronic): 1532-3064

Publisher: W.B. Saunders Ltd

URL: https://doi.org/10.1016/j.rmed.2018.06.031

DOI: 10.1016/j.rmed.2018.06.031


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