SSAT - Inhaled Beta Agonist Bronchodilator Does Not Affect Transdiaphragmatic Pressure Gradient But Decrease Lower Esophageal Sphincter Retention Pressure in Patients With Chronic Pulmonary Obstructive Disease (COPD) and Gastroesophageal Reflux Disease (GERD)

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Inhaled Beta Agonist Bronchodilator Does Not Affect Transdiaphragmatic Pressure Gradient But Decrease Lower Esophageal Sphincter Retention Pressure in Patients With Chronic Pulmonary Obstructive Disease (COPD) and Gastroesophageal Reflux Disease (GERD)
Leonardo M. Del Grande¹, Fernando A. Herbella^*¹, Marco G. Patti²
¹Surgery, Unifesp, SãoPaulo, São Paulo, Brazil; ²Surgery, University of Chicago, Chicago, IL

Introduction: Chronic pulmonary obstructive disease (COPD) patients have a high incidence of gastroesophageal reflux disease (GERD) whose pathophysiology seems to be linked to an increased transdiaphragmatic pressure gradient and not to a defective esophagogastric barrier. Inhaled beta agonist bronchodilators are a common therapy used by patients with COPD. This drug knowingly leads to a decrease in the lower esophageal sphincter (LES) resting pressure, favoring GERD; but also may improve ventilatory parameters, disfavoring GERD.
Aims: This study aim to evaluate the effect of inhaled beta agonist bronchodilators in the transdiaphragmatic pressure gradient and the esophagogastric barrier.
Methods: We studied 21 patients (mean age 67 years, 57% males) with COPD and GERD. All patients underwent high resolution manometry (HRM) and esophageal pH monitoring. Abdominal and thoracic pressure, transdiaphragmatic pressure gradient (abdominal - thoracic pressure) and the LES retention pressure (LES basal pressure -transdiaphragmatic gradient) were measured by HRM before and 5 minutes after inhaling beta agonist bronchodilators.
Results: Results are presented in table below. In summary, the administration of inhaled beta agonist bronchodilators lead to: (a) a simultaneous increase in abdominal and thoracic pressure not affecting the transdiaphragmatic pressure gradient and (b) a decrease in the LES resting pressure decreasing the LES retention pressure.
Conclusion: In conclusion, inhaled beta agonist bronchodilators improve thoracic pressure but also lead to an increased abdominal pressure favoring GERD by affecting the esophagogastric barrier.
Results
Abdominal pressure (mmHg) Thoracic pressure (mmHg) transdiaphragmatic pressure gradient (mmHg) lower esophageal sphincter resting pressure (mmHg) lower esophageal sphincter retention pressure (mmHg)
lower esophageal sphincter retention pressure (mmHg) 10.6±4.75 0.76±6.36 9.97±6.85 22.44±10.35 10.47±10.44
After beta agonist 12.8±3.75 2.85±4,52 9.43±4.35 13.26±5.65 3.82±5.03
p 0.0142 0.0076 0.57 <0.001 0.001
Confidence interval -3.747 to -0.472 -3.559 to -0.622 -1.398 to 2.464 4.044 to 10.318 3.024 to 10.272

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