Open AccessComparison of the effects of esomeprazole and fundoplication on airway responsiveness in patients with gastro‐oesophageal reflux disease
Author(s) -
Kiljander Toni,
Rantanen Tuomo,
Kellokumpu Ilmo,
Kööbi Tiit,
Lammi Lauri,
Nieminen Markku,
Poussa Tuija,
Ranta Arto,
Saarelainen Seppo,
Salminen Paulina
Publication year - 2013
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12005
Subject(s) - medicine , esomeprazole , methacholine , reflux , exhaled nitric oxide , concomitant , asthma , gastroenterology , proton pump inhibitor , esophageal ph monitoring , gerd , anesthesia , respiratory disease , disease , lung , spirometry
Gastro‐oesophageal reflux disease ( GORD ) is suggested to cause or aggravate several respiratory conditions. Studies with proton pump inhibitors have resulted in only minor improvements in pulmonary outcomes in patients with GORD . It has been speculated that operative treatment of GORD might be more efficient as it also diminishes non‐acidic reflux. Objectives To compare the effects of esomeprazole 40 mg bid and fundoplication on airway responsiveness, forced expiratory volume in 1 s ( FEV 1 ), exhaled nitric oxide ( NO ) and respiratory symptoms in patients with moderate‐to‐severe GORD . Methods Sixty‐nine GORD patients had methacholine inhalation challenge performed on them, and FEV 1 , exhaled NO and respiratory symptoms were measured at baseline, after a 3‐month treatment with esomeprazole and 3 months after fundoplication. Primary outcome variable was dose‐response slope ( DRS ), i.e. decline in FEV 1 during methacholine challenge divided with the amount of methacholine administered (%/μmol). Pre‐defined subgroup analysis was performed among those with concomitant asthma ( n = 12). Results There was no improvement in DRS , FEV 1 or exhaled NO after esomeprazole treatment or fundoplication. Cough and dyspnoea measured with visual analog scale improved with esomeprazole treatment ( P < 0.001), and further after fundoplication ( P < 0.001). Among those with concomitant asthma, significant improvements in S t G eorge R espiratory Q uestionnaire ( SGRQ ) scores could be seen after fundoplication. Conclusions Neither esomeprazole treatment nor fundoplication diminishes airway responsiveness or exhaled NO , or improves FEV 1 in patients with GORD . Improvements in respiratory symptoms and SGRQ scores after GORD treatments could be detected. However, as this was not a placebo‐controlled study, the findings in these secondary endpoints should not be emphasised. C linical T rials.cov: NCT 00994708.