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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 10/2016

01-10-2016 | 2016 SSAT Poster Presentation

Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)

Authors: Leonardo M. Del Grande, Fernando A. M. Herbella, Amilcar M. Bigatao, Jose R. Jardim, Marco G. Patti

Published in: Journal of Gastrointestinal Surgery | Issue 10/2016

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Abstract

Background

Chronic obstructive pulmonary disease (COPD) patients have a high incidence of gastroesophageal reflux disease (GERD) whose pathophysiology seems to be linked to an increased trans-diaphragmatic pressure gradient and not to a defective esophagogastric barrier. Inhaled beta agonist bronchodilators are a common therapy used by patients with COPD. This drug knowingly not only leads to a decrease in the lower esophageal sphincter (LES) resting pressure, favoring GERD, but also may improve ventilatory parameters, therefore preventing GERD.

Aims

This study aims to evaluate the effect of inhaled beta agonist bronchodilators on the trans-diaphragmatic pressure gradient and the esophagogastric barrier.

Methods

We studied 21 patients (mean age 67 years, 57 % males) with COPD and GERD. All patients underwent high-resolution manometry and esophageal pH monitoring. Abdominal and thoracic pressure, trans-diaphragmatic pressure gradient (abdominal–thoracic pressure), and the LES retention pressure (LES basal pressure–transdiaphragmatic gradient) were measured before and 5 min after inhaling beta agonist bronchodilators.

Results

The administration of inhaled beta agonist bronchodilators leads to the following: (a) a simultaneous increase in abdominal and thoracic pressure not affecting the trans-diaphragmatic pressure gradient and (b) a decrease in the LES resting pressure with a reduction of the LES retention pressure.

Conclusion

In conclusion, inhaled beta agonist bronchodilators not only increase the thoracic pressure but also lead to an increased abdominal pressure favoring GERD by affecting the esophagogastric barrier.
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Metadata
Title
Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)
Authors
Leonardo M. Del Grande
Fernando A. M. Herbella
Amilcar M. Bigatao
Jose R. Jardim
Marco G. Patti
Publication date
01-10-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 10/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3192-1

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