Consequently, esophageal receptors become increasingly sensitive to refluxed material. Once stimulated, the receptors transmit a signal that results in constriction of the bronchioles. Typical symptoms in the asthmatic patient include recurrent heartburn that radiates up and down the chest, that worsens when lying down or bending over, or that abates with the ingestion of water or antacids. Acid regurgitation into the throat is also common. However, in many patients, even a careful history may not suggest GERD because of minimal or absent esophageal symptoms.
Some patients complain of pain with swallowing or chest pain that mimics angina.
Others have no digestive symptoms but have pulmonary manifestations that result from reflux, such as nocturnal cough, recurrent pneumonia, sinusitis or otitis. If symptoms persist while on therapy, or return after successful therapy, diagnostic testing is warranted. The gold standard for the evaluation of patients with atypical reflux is 24 hour pH monitoring of the esophagus, although it is used infrequently. By monitoring a patient over a 24 hour period, data on correlated respiratory symptoms with actual episodes of reflux can be obtained. While antireflux therapy such as H-2 blockers, proton pump inhibitors and prokinetics effectively relieve GERD symptoms, the effect on asthma may be less dramatic.