Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)

Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)

Author Del Grande, Leonardo de Mello Autor UNIFESP Google Scholar
Herbella, Fernando Augusto Mardiros Autor UNIFESP Google Scholar
Jardim, Jose Roberto Autor UNIFESP Google Scholar
Patti, Marco G. Google Scholar
Abstract Background Chronic obstructive pulmonary disease (COPD) patients have a high incidence of gastroesophageal reflux disease (GERD) whose pathophysiology seems to be linked to an increased trans-diaphragmatic pressure gradient and not to a defective esophagogastric barrier. Inhaled beta agonist bronchodilators are a common therapy used by patients with COPD. This drug knowingly not only leads to a decrease in the lower esophageal sphincter (LES) resting pressure, favoring GERD, but also may improve ventilatory parameters, therefore preventing GERD. Aims This study aims to evaluate the effect of inhaled beta agonist bronchodilators on the trans-diaphragmatic pressure gradient and the esophagogastric barrier. Methods We studied 21 patients (mean age 67 years, 57 % males) with COPD and GERD. All patients underwent high-resolution manometry and esophageal pH monitoring. Abdominal and thoracic pressure, trans-diaphragmatic pressure gradient (abdominal-thoracic pressure), and the LES retention pressure (LES basal pressure-transdiaphragmatic gradient) were measured before and 5 min after inhaling beta agonist bronchodilators. Results The administration of inhaled beta agonist bronchodilators leads to the following: (a) a simultaneous increase in abdominal and thoracic pressure not affecting the trans-diaphragmatic pressure gradient and (b) a decrease in the LES resting pressure with a reduction of the LES retention pressure. Conclusion In conclusion, inhaled beta agonist bronchodilators not only increase the thoracic pressure but also lead to an increased abdominal pressure favoring GERD by affecting the esophagogastric barrier.
Keywords Chronic obstructive pulmonary disease
Gastroesophageal reflux disease
Trans-diaphragmatic pressure gradient
Bronchodilators
High-resolution manometry
Ambulatory pH monitoring
xmlui.dri2xhtml.METS-1.0.item-coverage New York
Language English
Date 2016
Published in Journal Of Gastrointestinal Surgery. New York, v. 20, n. 10, p. 1679-1682, 2016.
ISSN 1091-255X (Sherpa/Romeo, impact factor)
Publisher Springer
Extent 1679-1682
Origin http://dx.doi.org/10.1007/s11605-016-3192-1
Access rights Closed access
Type Article
Web of Science ID WOS:000384552600002
URI https://repositorio.unifesp.br/handle/11600/57023

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