Antireflux Therapy May Help Obese Bronchiectasis Patients with GERD

Antireflux Therapy May Help Obese Bronchiectasis Patients with GERD

Obese bronchiectasis patients with gastroesophageal reflux disease (GERD) may benefit from antireflux proton pump inhibitors according to researchers at the Seoul National University Bundang Hospital, in Korea.

The study “Effect of Proton Pump Inhibitors in Bronchiectatic Patients with Gastroesophageal Reflux Disease,” was published in the journal The Korean Society of Gastroenterology.

Bronchiectasis is easily complicated by the coexistence of other conditions, including GERD which is a digestive disorder caused when the ring of muscle (lower esophageal sphincter) between the esophagus and stomach does not function properly and allows stomach’s content to back up into the esophagus.

About 40% of  bronchiectasis patients have GERD, which is associated with worse lung function. Although some studies report benefits of antireflux surgery for bronchiectasis patients with GERD, little is known about the surgical benefits.

The research team sought to determine the effect of proton pump inhibitors (PPIs) as antireflux therapies for bronchiectasis and GERD. Researchers enrolled 257 patients (average age 67), 27 of which received PPIs, and 230 who received non-PPI treatment. Both groups underwent pulmonary function tests at the beginning and then within six months after therapy.

Results revealed that PPI therapy did not improve the forced vital capacity (FVC) test or the forced expiratory volume in one second (FEV1) test. But when patients were categorized by BMI, researchers found that PPIs significantly improved FVC and FEV1 in mild obese patients (BMI from 25 to 30).

Antireflux surgery is an anatomical repair, which prevents the reflux of both acid and non-acid materials. PPIs only prevent the reflux of acid materials, leading the researchers to surmise that PPIs did not change the lung parameters.

Investigators believe PPIs have an effect in patients with higher BMI because obesity increases the esophageal acid exposure time, compared to non-obese patients. Though the study was retrospective and patients received PPIs from 22 days to 1,784 days – the results suggest that obese bronchiectasis patients with GERD may benefit from PPI therapy.