Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux.

Patients presenting to a chest clinic because of adult-onset wheezing with no history of allergy had a 90 percent prevalence of gastroesophageal reflux, even though reflux symptoms were mild or absent. Ninety patients were randomly assigned to receive cimetidine or an identical placebo or to undergo antireflux surgery. During a six-month period, all groups improved clinically; the cimetidine and surgical groups improved more than the placebo group. The intake of pulmonary medication decreased significantly in both cimetidine and surgical groups. Pulmonary function test results improved in the cimetidine- and surgically treated patients; improvement was not statistically significant. At long-term follow-up, the surgical group maintained clinical improvement and decreased pulmonary medication intake, whereas the placebo group worsened. We conclude that gastroesophageal reflux can play a significant role in some patients with nonallergic pulmonary disease and that its treatment can improve pulmonary symptoms and objective measurements of pulmonary function.

Esophageal reflux--an unrecognized cause of recurrent obstructive bronchitis in children.

Forty-three children with recurrent obstructive bronchitis but without prominent gastrointestinal symptoms were studied for esophageal reflux roentgenographically and by manometry. Roentgenographic evidence for reflux was shown in 26; these patients had a mean lower esophageal sphincter pressure of 6.3 mm Hg as compared to a mean LES pressure of 21.9 mm Hg in normal control infants. The remaining 17 patients had a mean LES pressure of 10.0 mm Hg, also significantly lower than that of control subjects. Fifteen of 20 patients with recurrent obstructive bronchitis noted alleviation of their pulmonary symptoms after medical treatment of their reflux. Sequential studies of another group with radiologically demonstrated reflux showed increases in sphincter pressures and disappearance of radiologically observed reflux in one third of the patients. It is suggested that esophageal reflux should be sought in patients with recurrent bronchitis: if found, antireflux therapy might be expected to improve the pulmonary symptomatology.

Surgical correction of reflux. An effective therapy for esophageal strictures.

An effective antireflux operation, posterior gastropexy with cardiac calibration, was performed on 24 patients with well established peptic strictures of the esophagus. Without intraoperative or postoperative dilation, the diameter of the strictures went from a mean of 6.3 mm to a postoperative mean diameter of 13.0 mm. Significant increases in sphincter pressure were recorded and endoscopic evaluation showed a return to normal. Preoperative dysphagia was relieved. It is concluded that an adequate antireflux operation will obviate the need for postoperative dilations or more formidable operations such as interposition.