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GERD's Effect on Lungs and Lung Disease

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From Heartburn to Asthma
 
MADISON - A healthy stomach produces acid with a pH between 1 and 2, which is around a million times more acidic than pure water, and capable of dissolving metal. The stomach is able to protect its delicate tissues from that high level of acidity. Lungs, on the other hand, cannot.

UW Health thoracic surgeon James Maloney, MD, and his research team have been examining the effects of gastric reflux on lungs with the hope of improving the success rates of - or reducing the need for - lung transplants. His work was recently recognized by the CHEST Foundation with its Clinic Research Award in Lung Transplantation.

"Lung transplantation has the poorest long-term survival of all organ transplantations," Dr. Maloney says. "To improve, we need to dig deeper not only into the causes of that low survival rate, but also into common causes of chronic lung disease."

The relationship between gastroesophageal reflux disease (GERD) and chronic lung diseases such as idiopathic pulmonary fibrosis or asthma has been established for some time. GERD is believed to lead to collagen type V sensitization, which is a mediator of lung injury.
 
Heightened Patient Awareness of GERD: Controlling Symptoms vs. Correction
 
The heightened patient awareness of GERD over recent years has focused more on controlling symptoms over correcting the disorder, and while prescription and over-the-counter medications are successful in reducing the discomfort of GERD, changing the acid into an alkaline does not stop it from damaging lung tissue.

For lung transplant patients, GERD increases the possibility of primary graft dysfunction and rejection. Dr. Maloney's study asks if more aggressive anti-reflux measures could improve transplantation survival rates and quality of life for people with chronic lung disease.

"A post-transplant fundoplication (surgery strengthening the valve between the esophagus and stomach) may reduce the risk for rejection," Maloney says. "That leads us to the question: Would a pre-transplant fundoplication lower the chance for primary graft dysfunction? If done early enough, could it reduce the need for a transplant in the first place, or at least slow the progression of the disease?"

The Importance of Early Referral
 
Dr. Maloney says early referral is key, to assess the level of GERD and how, if at all, it is contributing to the lung disorder. Patients who develop asthma, unexplained shortness of breath or chronic cough later in life are at particular risk.

"Reflux surgery is not benign - if there is no evidence of significant lung disease, standard medication is the better way to go to treat symptoms," Dr. Maloney says. "If there are signs of a serious problem, however, fundoplication may slow down the progression and ultimately reduce the need for lung transplants overall."
 
Learn more about UW Health's Transplant Program
 
Date published: 4/28/2008