Gastro-oesophageal reflux, reflux-associated respiratory symptoms and severity of Chronic Obstructive Pulmonary Disease in Sri Lankan patients.

Background/Aim: Gastro-oesophageal reflux disease (GORD) and reflux-associated respiratory (RAR) symptoms are common in chronic obstructive pulmonary disease (COPD) patients. The effect of severity of COPD on presence of GORD and RAR symptoms has not been assessed previously in Sri Lanka. This study evaluated this relationship in a cohort of Sri Lankan COPD patients. Methods: A validated GORD screening questionnaire assessed frequency and severity of 7 GORD and 5 RAR symptoms, in 67 COPD patients (83.6% male, mean age (SD) 66.8 (10.2) years) and 69 comparable controls (71% male, mean age (SD) 66.2 (8.1) years). The subjects were GORD symptom positive if the composite GORD score was ≥ 12.5. Medication use, smoking history and spirometry were also recorded. Results: The mean (SD) GORD symptom score of COPD patients; 29.9 (20.6) was higher than controls; 10.6 (5.2);P<0.001. Cough was the most common GORD symptom, followed by heartburn, abdominal fullness and belching. Forty six (68.7%) COPD patients experienced at least one RARS compared to 1(1.4%) control;P<0.001. Having adjusted for medication use and having eversmoked, the prevalence of GORD symptoms in COPD patients; 73.3% (95%CI, 62.2%-84.0%) was significantly higher than controls; 26.0% (95%CI, 15.4%-36.7%). Based on post-bronchodilator FEV1, 13.4%, 40.3% and 46.3% had mild, moderate and severe COPD. There was significant association of COPD severity with presence of RARS but not GORD symptoms. Conclusion: GORD symptoms and RARS are common in Sri Lankan adult COPD patients. Reflux-associated respiratory symptoms are more common in more severe forms of the disease.