Relationship between gastro-oesophageal reflux and airway diseases: the airway reflux paradigm

Arch Bronconeumol. 2011 Apr;47(4):195-203. doi: 10.1016/j.arbres.2011.02.001. Epub 2011 Apr 2.


Our understanding of the relationship between gastro-oesophageal reflux and respiratory disease has recently undergone important changes. The previous paradigm of airway reflux as synonymous with the classic gastro-oesophageal reflux disease (GORD) causing heartburn has been overturned. Numerous epidemiological studies have shown a highly significant association of the acid, liquid, and gaseous reflux of GORD with conditions such as laryngeal diseases, chronic rhinosinusitis, treatment resistant asthma, COPD and even idiopathic pulmonary fibrosis. However, it has become clear from studies on cough hypersensitivity syndrome that much reflux of importance in the airways has been missed, since it is either non- or weakly acid and gaseous in composition. The evidence for such a relationship relies on the clinical history pointing to symptom associations with known precipitants of reflux. The tools for the diagnosis of extra-oesophageal reflux, in contrast to the oesophageal reflux of GORD, lack sensitivity and reproducibility. Unfortunately, methodology for detecting such reflux is only just becoming available and much additional work is required to properly delineate its role.

Publication types

  • Review

MeSH terms

  • Bile Acids and Salts / analysis
  • Biomarkers
  • Bronchoalveolar Lavage Fluid / chemistry
  • Combined Modality Therapy
  • Comorbidity
  • Dopamine Agonists / therapeutic use
  • Follow-Up Studies
  • Fundoplication
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / physiopathology
  • Gastroesophageal Reflux / therapy
  • Heartburn / drug therapy
  • Heartburn / epidemiology
  • Heartburn / etiology
  • Humans
  • Laryngopharyngeal Reflux / epidemiology
  • Laryngopharyngeal Reflux / physiopathology
  • Laryngoscopy
  • Lung Transplantation
  • Meta-Analysis as Topic
  • Models, Biological
  • Pepsin A / analysis
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Proton Pump Inhibitors / therapeutic use
  • Respiratory Aspiration / epidemiology
  • Respiratory Aspiration / etiology*
  • Respiratory Aspiration / physiopathology
  • Respiratory Tract Diseases / epidemiology
  • Respiratory Tract Diseases / etiology*
  • Respiratory Tract Diseases / physiopathology
  • Severity of Illness Index
  • Sleep Disorders, Intrinsic / etiology


  • Bile Acids and Salts
  • Biomarkers
  • Dopamine Agonists
  • Proton Pump Inhibitors
  • Pepsin A