Gastroesophageal reflux disease, acid suppression, and Mycobacterium avium complex pulmonary disease

Chest. 2007 Apr;131(4):1166-72. doi: 10.1378/chest.06-1906.


Background: Weekly symptoms of gastroesophageal reflux disease (GERD) occur in 20% of the population, and GERD has been implicated in the pathophysiology of many respiratory diseases. Microaspiration of contaminated water is a potential portal of entry for Mycobacterium avium complex (MAC) organisms into the respiratory tract, and acid-suppression therapy may enhance the survival of mycobacteria in the stomach. This study aimed to assess the prevalence of GERD, swallowing disorders, reflux symptoms, and acid-suppression therapy in patients with MAC lung disease (MAC positive [MAC+]), and to compare these patients to control subjects without MAC lung disease (MAC negative [MAC-]).

Methods: Clinical information was collected on 58 MAC+ patients and 58 age- and sex-matched MAC- patients who were asked to complete a DeMeester questionnaire of reflux symptoms and to identify any acid-suppressive medication consumed.

Results: A clinical diagnosis of GERD was documented in 23 of 52 MAC+ patients (44.2%), compared to 16 MAC- patients (27.6%) [p = 0.019]. MAC+ patients consumed significantly more histamine type 2 receptor antagonists and prokinetic agents, and MAC- patients consumed more antacids. The mean DeMeester questionnaire score (+/- SD) for MAC+ patients was 1.39 +/- 1.8, and for MAC- patients was 0.88 +/- 1.4. (p = 0.098). Aspiration was suspected in nine MAC+ patients (15.5%), compared to three MAC- patients (5.2%) [p = 0.032]. There was no association between GERD and radiologic presentation of MAC disease. Consolidation and nodules > 5 mm were more common in those receiving acid suppression than those who were not.

Conclusions: GERD, acid suppression, and clinically suspected aspiration are more common in patients with MAC lung disease than in similar patients without MAC disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antacids / therapeutic use*
  • Enzyme Inhibitors / therapeutic use*
  • Female
  • Follow-Up Studies
  • Gastric Acid / metabolism
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / metabolism
  • Gastroscopy
  • Histamine H2 Antagonists / therapeutic use*
  • Humans
  • Lung Diseases / epidemiology
  • Lung Diseases / etiology*
  • Lung Diseases / microbiology
  • Male
  • Middle Aged
  • Mycobacterium avium Complex / isolation & purification
  • Mycobacterium avium-intracellulare Infection / epidemiology
  • Mycobacterium avium-intracellulare Infection / etiology*
  • Mycobacterium avium-intracellulare Infection / microbiology
  • Prevalence
  • Prospective Studies
  • Proton Pump Inhibitors*
  • Queensland / epidemiology
  • Sputum / microbiology
  • Treatment Outcome


  • Antacids
  • Enzyme Inhibitors
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors