Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review.

The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies.
Competing Interests: Conflict of interest: M.J. McDonnell reports grants from Health Research Board Ireland and the European Respiratory Society during the conduct of the study. Conflict of interest: E.B. Hunt reports grants from University College Cork during the conduct of the study. Conflict of interest: C. Ward has nothing to disclose. Conflict of interest: J.P. Pearson has nothing to disclose. Conflict of interest: D. O'Toole reports grants from Health Research Board Ireland and Science Foundation Ireland during the conduct of the study. Conflict of interest: J.G. Laffey has nothing to disclose. Conflict of interest: D.M. Murphy reports a UCC Translational Research Access Programme Award during the conduct of the study; personal fees and nonfinancial support from AstraZeneca and Novartis, personal fees from Teva, personal fees from Boehringer Ingelheim and GSK, and personal fees and nonfinancial support from Menarini and Bayer, outside the submitted work. Conflict of interest: R.M. Rutherford has nothing to disclose.
(Copyright ©ERS 2020.)