الفهرس 
Gastroesophageal reflux diseaseOnly 14 pages are availabe for public view
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Abstract
This work was carried out on 60 person. They were 16 male and 44
female and their ages were ranging from 35-57 year with a mean value of 45
year. They were chosen from inpatient and outpatient of Chest Department in
Menoufiya University Hospital during the period, from 12-2006 to 8-2007.
They were categorized into four groups:
Group I:
This group included 15 patients with bronchial asthma.
Group II:
This group included 15 Patients with mild COPD.
Group III:
This group included 15 patients with moderate COPD.
Group IV:
This group included 15 healthy volunteers as control group.
The inclusion criteria for COPD patients were:
(1) History of COPD.
(2) Reversibility of FEV1<_15% after 400 mg salbutamol inhalation and
without use of steroids for 2 weeks at least (Stavem et al., 2005).
(3) Abnormal findings on spirometry demonstrating nonreversible airway
obstruction based on GOLD classification (Mild COPD FEV1 >_80% &
FEV1/FVC ratio < 70% of predicted and Moderate COPD 30%>FEV1<80%
and FEV1/FVC ratio < 70% of predicted <15% improvement in FEV1 after
inhaling salbutamol).
The inclusion criteria for asthma patients were:
(1) History of asthma.
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(2) The degree of reversibility in FEV1 which indicates a diagnosis of asthma
is generally accepted as ≥ 15% from the pre-bronchodilator value (Stavem et
al., 2005).
The patients who not met our inclusion criteria were excluded.
Before entering the study, informed consent was obtained from each subject.
The diagnosis of GEDR was based on modified version of a previously
validated Mayo clinic GER questionnaire developed by Locke and associates
(Choy, 1997). This questionnaire was simple, understandable and well
accepted by the COPD patients, the bronchial asthma patients and control
subjects.
Statistical analysis consisted of t-test for comparing means, for association
between variables X2 square test was employed and for value of significancy
used P value.
They underwent the following:
Complete history taking.
Full clinical examination.
Laboratory investigations.
Abdominal ultrasonography.
ECG.
Plain chest x-ray postero-anterior and left lateral view.
Pulmonary function tests including:
Peak expiratory flow rate (PEFR) which measures maximum volume during
forced expiration measured using the Wright, peak flow meter before and 20
minutes after administration of a bronchodilator. This test shown to be effort
dependant, so we used FEV1.
Spirometry measures the volume of air forcibly exhaled from the point of
maximal inspiration (forced vital capacity, FVC) and the volume of air exhaled
during the first second of this maneuver (forced expiratory volume in one
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126
second, FEV1), and the ratio of these two measurements (FEV1/FVC) should
be calculated.
Spirometry measurements are evaluated by comparison with reference
values based on age, height, sex, and race (Pellegrino et al., 2005).
Esophagogastroduodenoscopy.
Chromoendoscopy: using Lugol’s solution
The present study has revealed that:
- There was significantly higher % of males in COPD group than in asthma and
controls. The same results occurred regarding smoking.
- There was significantly longer duration of disease in COPD than in asthma.
- There was significant difference in the amount of smoking between COPD
and bronchial asthma patients with significant GERD and COPD and
bronchial asthma patients with insignificant gastroesophageal reflux
symptoms to be higher % in COPD patients.
- There was significantly higher prevalence of significant reflux, heartburn,
acid regurgitation in bronchial asthma patient than controls.
- There was significantly higher prevalence of all GERD symptoms in COPD
patients than controls.
- There was no significant difference between mild and moderate COPD
patients regarding GERD symptoms.
- There was no significant difference in predicted FEV1% and predicted
FEV1/FVC % whether in significant GERD or insignificant GERD either in
asthma or in COPD.
- There was a significantly lower mean value of PEFR in COPD patients with
GERD symptoms than those without.
- Moderate COPD patients with GERD showed significant increase in the
exacerbations than mild ones.
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- There was no significant difference between bronchial asthma patients with
GER symptoms regarding exacerbations of the disease.
- There was a significant difference between the studied groups regarding use
of anti-reflux treatment.
- There was significantly higher percent of positive endoscopic cases in
COPD patients than asthma and controls. Hiatus hernia presence was
insignificant both in asthma and COPD patients.
- There was significantly higher percent of positive endoscopic cases in
asthma patients with GER symptoms than those without.
- There was significantly higher percent of positive endoscopic cases in
COPD patients with insignificant GERD symptoms than those with.
from the present study we could conclude that:
-A higher proportion of gastroesophageal reflux symptoms were present in
COPD patients compared to asthma and control subjects.
-Most of the patients with COPD lacked typical gastro-oesophageal reflux
disease symptoms; however they were positive with endoscopy.
-There was a trend toward higher prevalence of GER symptoms in patients
with moderate COPD than mild COPD; however, this difference did not reach
statistical significance.
-Anti-reflux medication use is higher in COPD group so this suggests using
anti-reflux treatment in these patients considaring its effects on the chest
condition and exacerbations.
-Patients who have moderate COPD and also have reflux symptoms at least
once a week are more likely to have an increased number of COPD
exacerbations when compared to mild COPD patients who also have reflux
symptoms at least once a week. This is true despite no significant difference
in FEV1 percentage of predicted between the two groups.
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128
-None of the asthma or COPD medicatins were associated with an increase of
reflux symptoms.
-The association between asthma and GER shows that GER is prevalent in
patients with asthma than controls that esophageal acid may alter airway
hyperresponsiveness, and that medical or surgical GER therapy may improve
asthma outcome in selected individuals.
-There is a high prevalence of GER in asthmatics. Asthmatics without reflux
symptoms may require esophageal pH testing to detect GER. further
supporting the hypothesis that GER may be a potential trigger of asthma.
-Despite the strong association between GER and asthma, and intensive study
by a number of investigators, there is little evidence to support the hypothesis that either spontaneous GER or AP has an effect on lung function in
asthmatics.