12/20/04 Gastro esophageal reflux during sleep - effect on asthmaSummary Findings - The subject of GER-sl was review by Sexton and Harding of the Univ. of Alabama. Ger-sl is a distinct entity thought to be due to excessive relaxation of the lower esophageal sphincter during the sleep period, particularly during transient arousals. Although typical reflux esophageal symptoms such as heartburn and regurgitation are common in GER-sl, they are not present in all cases. Extra esophageal manifestations such as disordered sleep, aggravation of underlying asthma and laryngospasm may also occur. Of particular irrelevance to this website was the discussion of effects of GER-sl on asthma. It has been shown that GER-sl can increase bronchial hyper-reactivity and trigger nocturnal asthma episodes. In epidemiologic studies, asthma was more common in those with GER-sl. This was manifest by a higher frequency in GER-sl patients of wheezing, dyspnea at rest and at night, cough and variability in peak expiratory flow rates. In some cases, pronounced GER-sl leads to acid reflux into the trachea resulting in decreased expiratory airflow. GER-sl episodes were also associated with increased respiratory resistance. The therapy of GER-sl includes: 1) avoid eating for 2 hours prior to sleep; 2) elevation of the head of the bed by 6 inches (or sleep on the left side if head elevation not tolerated); 3) stop smoking; 4) reduce intake of foods that contribute to GER (caffeine, chocolate, alcohol, tomato products, sodas); 5) avoid certain medications, may promote GER (Ca++ channel blockers, anti-cholinergics, the ophyllines, certain sedatives, bisphosphonates; 6) treatment with proton pump inhibitors, possibly H2 blockers and low dose prokinetic agents. Reference Editor's Comments
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