Gastric Asthma: A Vagally-Mediated Disease

Many evidences show that bronchial asthma may be triggered or enhanced by gastroesophageal reflux (GER) even if standardized methods to detect this particular syndrome defined as “gastric asthma” are not available. The Bernstein test suitably modified was performed in 6 adult asthmatic outpatients when they were symptom-free. These subjects were also suffering from recurrent epigastric pain. The patients resulted positive to ultranebulized fog bronchial challenge and all had a moderate- severe alteration of the competency of the lower esophageal sphincter, shown by endoscopy. Functional lung parameters were significantly reduced after esophageal acidification when they were compared to basal values.

Is the linkage between GER and asthma important in clinical practice? In asthmatic patients GER represents an important trigger for broncoconstriction through a vagal mediated reflex. The modified Bernstein test represents a reproducible method and may be well used to identify “gastric asthma”, particularly when this picture is “silent”, less evident, or it is not rightly considered. Moreover, its recognition is very relevant to therapeutic problems, also when it is in a subclinical stage. In fact, many “excellent” drugs used for bronchial asthma treatment may have undesirable effects for the gastric tract causing abnormalities such as GER that is so damaging in the development of “gastric asthma”.