Evaluation and management of gastroesophageal reflux and pulmonary disease.

Gastroesophageal reflux and pulmonary disease have become causally associated owing to reports of improved pulmonary function in patients with asthma or stridor following antireflux pharmacotherapy or surgery. Mechanisms by which reflux causes pulmonary disease include direct aspiration and neural reflex arcs. A novel additional mechanism for acute life-threatening episodes implicates increased beta-endorphin levels resulting from acid-mediated esophageal pain in the depression of respiratory drive. Diagnostic modalities used in the evaluation of reflux have often been inadequate to demonstrate a cause-and-effect relationship between reflux and pulmonary disease. Recent studies using multiple site pH-metry have attempted to provide evidence for cause and effect but have achieved mixed results. Aggressive antireflux pharmacotherapy and, sometimes, surgery help those patients with chronic pulmonary disease mediated by gastroesophageal reflux.