Effects of Esophageal Acid Perfusion on Airway Hyperresponsiveness in Patients With Bronchial Asthma

The effects of gastroesophagealreflux on airway hyperresponsiveness in patients with bronchial asthmahave yet to be studied in significant detail. The purpose of thepresent study was to determine how esophageal acid perfusion couldchange airway responsiveness in patients with bronchial asthma. In seven patients withbronchial asthma (mean ± SD age, 55.1 ± 6.4 years; four women andthree men), esophageal p, H was monitored by a p, H meter and airwayresponsiveness was evaluated by aerosol inhalation of methacholine, during esophageal perfusion through an esophageal tube filled witheither saline solution or 0.1N hydrochloric acid (HCl), the order ofwhich was selected at random, in 1-week intervals. Spirometry was alsoperformed during esophageal p, H monitoring. Asignificant decrease in the geometric mean of airway sensitivity or theconcentration of methacholine causing a 35% fall in respiratoryconductance was observed during esophageal HCl perfusion compared withthat of saline solution perfusion (p < 0.01 or p < 0.003),although no significant changes were observed in vital capacity,FEV1, peak expiratory flow, respiratory resistance, orslope of respiratory conductance during the periods of saline solutionand HCl perfusion. We concluded that anincrease in airway hyperresponsiveness was induced when HCl stimulatedthe esophagus in patients with bronchial asthma. These resultssuggest that esophageal reflux is one of the important factors thataggravate asthmatic status.