Studies of gastro-oesophageal reflux treatment in cystic fibrosis and bronchiectasis
| First author [ref] Study type | n | Treatment | CF symptoms | Exacerbations | FEV1 | Other outcomes |
| Cystic fibrosis | ||||||
| Malfroot [134] Prospective observational | 16 | Cisapride therapy | Improved weight gain and improved cough and wheeze | N/A | N/A | N/A |
| Brodzicki [135] Prospective observational | 19 | Cisapride or cisparide with ranitidine for 3 months | N/A | N/A | N/A | Improved GORD outcomes on pH analysis: decrease in reflux index, longest episode duration and the no. of episodes >5 min; improvement of endoscopic picture post-treatment |
| van der Doef [123] Prospective observational | 218 | Gastric acid inhibition (proton pump inhibitors or histamine-2 receptor antagonists) for fat malabsorption or GORD | N/A | N/A | GORD was associated with significantly reduced FEV1 and FVC Patients with gastric acid inhibition had a significantly smaller yearly decline of MEF50 and MEF25–75% | GORD was associated with an earlier acquisition of P. aeruginosa and S. aureus |
| Tran [136] Children Prospective observational | 15 | Lansoprazole 15 mg daily for 3 months | Improved faecal steatorrhoea | N/A | N/A | Significant improvements in fat mass nutritional status and bone mineral content |
| Hendriks [137] Prospective observational | 14 | Lansoprazole 30 mg daily for 1 year | Improved faecal steatorrheoa | N/A | Improved TLC, RV and inspiratory muscle capacity | Improved BMI, decreased fat losses and improved total body fat |
| Dimango [138] RCT | 17 | PPI (esomeprazole 40 mg BD) for 36 weeks | N/A | Trend to earlier exacerbation and more frequent exacerbations in esomeprazole group | FEV1 unchanged | No change in Gastroesophageal Symptom Assessment Score or CF Quality of Life score between the two groups |
| Zeybel [133] Prospective observational | 12 | Ivacaftor (CF patients with G511D mutations) | N/A | N/A | Baseline FEV1 lower in patients with extra-oesophageal reflux symptoms | Improved extra-oesophageal reflux symptoms using the Reflux Symptom Index and the Hull Airways Reflux Questionnaire |
| Boesch [139] Children Prospective observational | 25 | Nissen fundoplication | N/A | N/A | No change in FEV1 or body mass index after fundoplication; children who had an FEV1 <60% predicted at time surgery had significantly improved FEV1 compared to those with FEV1 <60% | No mortality associated with fundoplication, but 12% had complications that required a subsequent surgical procedure |
| Fathi [145] Prospective observational | 6 | Nissen fundoplication | N/A | 50% reduction in exacerbations 2 years post-operatively | Small but significant improvement in FEV1 and FVC 2 years post-operatively | Improved cough symptoms using the Leicester Cough Questionnaire |
| Sheikh [146] Retrospective observational | Nissen fundoplication | Increased weight gain | Fewer pulmonary exacerbations | Slower decline in FEV1 2 years post-operatively | Better pulmonary and nutritional outcomes were noted among patients with milder lung disease compared to those with severe lung disease; no mortality associated with surgery | |
| Bronchiectasis | ||||||
| Ahn [159] Prospective observational | 257 | PPI therapy (any type) for 6 months | N/A | N/A | Unchanged Subgroup analyses showed significant improvement in lung function in patients with high BMI related to the severity of obesity | N/A |
| Hu [160] Prospective observational | 7 | Stretta radiofrequency (SRF) n=2 Laparoscopic fundoplication with or without hiatal hernia repair n=4 Combined n=1 | Improved | Improved exacerbations Improved hospitalisations | N/A | Improved GORD symptoms |
Abbreviations: CF: cystic fibrosis; FEV1: forced expiratory volume in 1 s; GORD: gastro-oesophageal reflux; FVC: forced vital capacity; MEF50: maximal expiratory flow at 50 % of FVC; MEF25–75%: mean expiratory flow at 25–75% of FVC; TLC: total lung capacity; RV: residual volume; BMI: body mass index; RCT: randomised controlled trial; PPI: proton pump inhibitor.