The "Forgotten" Relationship: GERD and Airway Disease
Posted May 17 2009 10:35pm
From the Preface of "GERD and Airway Disease": Clinical insights often appear to be new but may be found to have been previously recorded and either ignored or lost. This is certainly true regarding gastroesophageal reflux disease and asthma (and other airway diseases). In the Middle Ages, Maimonides noted that asthma occurred after feasting. In the late 1800s Sir William Osler noted a relationship between large evening meals and worsening nocturnal asthma. He stated that attacks may be due to direct irritation of the bronchial mucosa or indirectly, too, by reflex influences from the stomach. This wisdom seemed to be lost until 1934, when Bray proposed that late evening overindulgence caused gastric distention, which led to reflex-mediated bronchoconstriction through the vagus nerve. In 1976 when a report by Mays suggested that 50% of intrinsic asthmatics had gastroesophageal reflux, many felt the study was biased and the percentage too high. None, at the time, would have expected that future studies could show prevalence rates of as high as 80%. An ever increasing body of evidence supports the importance of gastroesophageal reflux disease (GERD) as a signifigant factor in both upper- and lower-airway disease. Until now, this information had not presented in a coordinated volume enabling both primary care providers and specialists to grasp these relationships. This book is designed to fill that void, which is also present in most textbooks on asthma and respiratory disease. It is unfortunate when patients present with severe laryngeal disease or late severe restrictive lung disease, which might have been prevented had these relationships not been missed. This text was published in 1999!