Assessment of Gastroesophageal Reflux Frequency and Its Clinical Impact in Severe Chronic Obstructive Pulmonary Disease

Abstract

Background: Gastroesophageal reflux disease (GERD) is commonly observed in patients with chronic respiratory disorders, yet its prevalence and clinical relevance in severe chronic obstructive pulmonary disease (COPD) remain underexplored. GERD may contribute to respiratory symptom burden and oxygen desaturation, particularly during nocturnal periods. However, many patients remain asymptomatic, complicating diagnosis based on clinical presentation alone. Objective: To evaluate the frequency of GERD and its association with clinical symptoms and oxygen desaturation in patients with severe COPD using objective pH monitoring, compared to age-matched healthy individuals. Methodology: This prospective investigation enrolled 32 male patients diagnosed with severe COPD (mean FEV₠% predicted: 36%, range: 22–50) and 32 age-matched healthy controls without respiratory or gastrointestinal complaints. GERD diagnosis was established through 24-hour esophageal pH monitoring. Symptom evaluation utilized the Vigneri scoring system, while respiratory function and health-related quality of life were assessed via standardized instruments. The study protocol received ethical approval from the institutional review board. Results: Among COPD patients, 22 individuals (66.7%) exhibited pathological acid reflux, compared to 7 controls (21.9%). Notably, over half of the GERD-positive patients reported no typical reflux symptoms. Clinical parameters, including pulmonary function and symptom burden, did not differ significantly between COPD patients with and without GERD. Importantly, oxygen desaturation events coincided with acid reflux episodes in 42% of GERD patients. Conclusion: This study highlights a significant incidence of silent GERD among severe COPD patients. The interplay between acid reflux and nocturnal oxygen desaturation merits further exploration.