Journal List > Korean J Gastroenterol > v.68(1) > 1007543

TOOLS
Ahn, Lee, Lee, Hwang, Yoon, Shin, Park, and Kim: Effect of Proton Pump Inhibitors in Bronchiectatic Patients with Gastroesophageal Reflux Disease
Original Article

Korean J Gastroenterol 2016;68(1):10-15.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.1.10

Effect of Proton Pump Inhibitors in Bronchiectatic Patients with Gastroesophageal Reflux Disease

Byungkyu Ahn1, Dong Ho Lee1, 2, Chang Min Lee1, Jae Jin Hwang1, Hyuk Yoon1, Cheol Min Shin1, Young Soo Park1, Nayoung Kim1, 2

1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

2Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: Dong Ho Lee, Department of Gastroenterology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel: +82-31-787-7006, Fax: +82-31-787-4051, E-mail: dhljohn@snubh.org

Received 1 February 2016       Revised 11 April 2016       Accepted 9 May 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Bronchiectasis is aggravated by gastroesophageal reflux disease (GERD) owing to micro aspiration. Some researchers note the effect of antireflux surgery in bronchiectasis with GERD. However, few have investigated the effects of medical antireflux therapy. We investigated the effect of proton pump inhibitors (PPIs) in bronchiectasis with GERD.

Methods

From March 2003 to May 2015, the clinical records of patients who had bronchiectasis with GERD were reviewed. Patients underwent an initial pulmonary function test (PFT) and chest computed tomography when diagnosed with bronchiectasis. One group with typical GERD symptoms was treated with PPIs, while the other group was not. Both groups underwent PFTs within six months after completing PPI therapy. Population characteristics and associations were compared between the groups.

Results

Two hundred and fifty-seven patients (124 male, 133 female; mean age 67.6±10.0 years) were included. There were no significant differences between the groups in terms of forced vital capacity (FVC; p=0.239), forced expiratory volume in one second (FEV1; p=0.555), or FEV1/FVC (p=0.374) after PPI therapy. However, there were significant improvements in FVC (p=0.002) and FEV1 (p=0.006) in patients with high BMI in the PPI treatment group.

Conclusions

PPIs have no effect on the pulmonary function in patients with bronchiectasis and GERD. However, PPIs were noted to produce improvements in lung function in patients with bronchiectasis and high BMI.

Keywords: Bronchiectasis, Gastroesophageal reflux, Proton pump inhibitors

References

1. Ilowite J, Spiegler P, Chawla S. Bronchiectasis: new findings in the pathogenesis and treatment of this disease. Curr Opin Infect Dis. 2008; 21:163–167.
crossref
2. Weycker D, Edelsberg J, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005; 12:205–209.
crossref
3. Chang AB, Bilton D. Exacerbations in cystic fibrosis:4–Non-cystic fibrosis bronchiectasis. Thorax. 2008; 63:269–276.
4. Tsang KW, Lam WK, Kwok E, et al. Helicobacter pylori and upper gastrointestinal symptoms in bronchiectasis. Eur Respir J. 1999; 14:1345–1350.
5. Kim JH. Are proton pump inhibitors effective in asthmatics with gastroesophageal reflux disease? Korean J Gastroenterol. 2011; 58:169–170.
crossref
6. Lee AL, Button BM, Denehy L, et al. Proximal and distal gas-tro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis. Respirology. 2014; 19:211–217.
crossref
7. Lee AL, Button BM, Denehy L, Wilson JW. Gastro-oesophageal reflux in noncystic fibrosis bronchiectasis. Pulm Med. 2011; 2011:395020.
crossref
8. Ozaydin I, Annakkaya AN, Ozaydin C, Aydın M. Effects of cruro-raphy and laparoscopic Nissen fundoplication procedures on pulmonary function tests in gastroesophageal reflux patients. Int J Clin Exp Med. 2014; 7:431–434.
9. Hu ZW, Wang ZG, Zhang Y, et al. Gastroesophageal reflux in bronchiectasis and the effect of anti-reflux treatment. BMC Pulm Med. 2013; 13:34.
crossref
10. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. Global Consensus Group. The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006; 101:1900–1920. quiz 1943.
crossref
11. Sweet MP, Patti MG, Hoopes C, Hays SR, Golden JA. Gastro-oesophageal reflux and aspiration in patients with advanced lung disease. Thorax. 2009; 64:167–173.
crossref
12. Schan CA, Harding SM, Haile JM, Bradley LA, Richter JE. Gastroesophageal reflux-induced bronchoconstriction. An intra-esophageal acid infusion study using state-of-the-art technology. Chest. 1994; 106:731–737.
13. Sweet MP, Herbella FA, Leard L, et al. The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation. Ann Surg. 2006; 244:491–497.
crossref
14. Tsang KW, Lam SK, Lam WK, et al. High seroprevalence of Helicobacter pylori in active bronchiectasis. Am J Respir Crit Care Med. 1998; 158:1047–1051.
15. Mégraud F. Toxic factors of Helicobacter pylori. Eur J Gastroenterol Hepatol. 1994; 6(Suppl 1):S5–S10.
16. Goodwin CS, Armstrong JA, Marshall BJ. Campylobacter pyloridis, gastritis, and peptic ulceration. J Clin Pathol. 1986; 39:353–365.
crossref
17. Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000; 162:1277–1284.
crossref
18. Shah SL, Lacy BE, DiBaise JK, Vela MF, Crowell MD. The impact of obesity on oesophageal acid exposure time on and off proton pump inhibitor therapy. Aliment Pharmacol Ther. 2015; 42:1093–1100.
crossref

Fig. 1.
Severity of obesity and lung function in patients with bronchiectasis and gastroesophageal reflux disease. (A) Differences in lung function between before and after antireflux treatment in the proton pump inhibitor (PPI) treatment group. (B) Differences in lung function between before and after antireflux treatment in the non-PPI treatment group. *p<0.05. FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; diff., difference in lung function parameters before and after anti-reflux treatment. Underweight: BMI <18.5; normal: BMI ≥18.5, <23; overweight: ≥23, <25; mildly obese: ≥25, <30; moderately obese: ≥30, <35; severely obese: BMI ≥35.
kjg-68-10f1.tif
Table 1.
Baseline Characteristics of the Non-PPI Treatment Group and the PPI Treatment Group
  Non-PPI treatment group (n=230) PPI treatment group (n=27) p-value
Age (yr) 67.1±10.0 71.6±8.5 0.032
Sex, male/female 116/114 8/19 0.041
BMI (kg/m2) 23.2±3.3 22.3±3.0 0.286
Drinking     0.171
 Ex-drinker 5 (2.2) 1 (3.7)  
 Current 38 (16.5) 4 (14.8)  
Smoking     0.815
 Ex-smoker 10 (4.3) 3 (11.1)  
 Current 30 (13.0) 5 (18.5)  
Diabetes mellitus 29 (12.6) 8 (29.6) 0.036
Hypertension 61 (26.5) 14 (51.9) 0.006
Pulmonary TB 55 (23.9) 15 (55.6) 0.000
CKD 3 (1.3) 2 (7.4) 0.087
GERD     0.162
 NERD 151 (65.7) 20 (74.1)  
 LA-A 23 (10.0) 1 (3.7)  
 LA-B 8 (3.5) 3 (11.1)  
 LA-C 0 (0) 1 (3.7)  
Pre-FVC (%) 91.6±16.2 87.1±16.9 0.257
Pre-FEV1 (%) 91.0±22.4 87.9±25.1 0.389
Pre-FEV1/FVC (%) 71.3±12.2 72.8±12.5 0.360

Values are presented as mean±SD or n (%).

PPI, proton pump inhibitor; TB, tuberculosis; CKD, chronic kidney disease; GERD, gastroesophageal reflux disease; NERD, non-erosive reflux disease; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second.

Table 2.
Comparison of Lung Function between Groups after PPI Treatment
  Non-PPI treatment group (n=230) PPI treatment group (n=27) p-value
Post-FVC (%) 90.3±17.8 84.5±20.7 0.239
Post-FEV1 (%) 90.3±22.9 87.9±28.0 0.555
Post-FEV1/FVC (%) 72.1±14.8 74.5±15.8 0.374
FVC diff. (%) −1.3±11.0 −2.6±13.0 0.975
FEV1 diff. (%) −0.7±11.2 0±11.9 0.611
FEV1/FVC diff. (%) 0.9±9.7 1.7±12.3 0.757

Values are presented as mean±SD.

PPI, proton pump inhibitor; diff., difference in lung function parameters before and after PPI treatment; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second.

Table 3.
Spearman Correlation between Lung Function Tests for the Two Groups
  Non-PPI treatment group (n=230)
 PPI treatment group (n=27)
FVC diff. FEV1 diff. FEV1/FVC diff. FVC diff. FEV1 diff. FEV1/FVC diff.
Age 0.100 0.002* 0.981 0.355 0.355 0.768
  (0.109) (0.207) (−0.002) (0.185) (0.185) (−0.060)
BMI 0.525 0.822 0.388 0.002* 0.006* 0.209
  (0.045) (0.016) (−0.061) (0.564) (0.513) (−0.250)
Severity of obesity 0.897 0.740 0.790 0.002* 0.008* 0.435
  (−0.009) (−0.023) (−0.019) (0.568) (0.501) (−0.157)
Current drinker 0.626 0.495 0.352 0.343 0.862 0.075
  (−0.042) (0.059) (0.081) (−0.194) (0.036) (0.355)
Current smoker 0.406 0.558 0.164 0.196 0.917 0.024*
  (−0.072) (0.051) (0.121) (−0.257) (−0.021) (0.434)
Diabetes mellitus 0.611 0.341 0.654 0.698 0.569 0.227
  (0.034) (0.063) (0.030) (−0.078) (0.115) (0.240)
Hypertension 0.355 0.510 0.510 0.670 0.887 0.869
  (0.061) (0.044) (0.044) (−0.086) (0.029) (0.033)
Pulmonary TB 0.400 0.635 0.635 0.026* 0.058 0.444
  (0.056) (−0.031) (−0.031) (−0.427) (−0.369) (0.154)
CKD 0.641 0.305 0.865 0.752 0.557 0.822
  (0.031) (0.068) (0.011) (−0.064) (−0.118) (−0.046)

Values are presented as p-value (rho).

PPI, proton pump inhibitor; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; diff., difference in lung function parameters before and after PPI treatment; TB, tuberculosis; CKD, chronic kidney disease.

* p<0.05.

Table 4.
Linear Regression Analysis of Lung Function with BMI and with Severity of Obesity in the PPI Treatment Group
  FVC diff.
 FEV1 diff.
B R2 p-value B R2 p-value
BMI 2.522 0.348 0.001 2.004 0.262 0.006
Severity of obesity 7.729 0.282 0.004 6.075 0.208 0.017

PPI, proton pump inhibitor; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; diff., difference in lung function parameters before and after PPI treatment.

TOOLS
Similar articles