Reflux Aspiration and Lung Disease

Pathology.- Diagnostic confusion through the ages.- Gastroesophageal reflux disease: an overview.- Chemical composition of refluxate.- Pathological processes.- Pathophysiology in the lung.- Effect of reflux on cough sensitivity and bronchial responsiveness.- Diagnosis.- Reflux diagnosis using questionnaires.- Pepsin detection as a diagnostic test for reflux disease.- Imaging reflux.- High resolution oesophageal manometry in the investigation of unexplained cough.- Cough monitoring in reflux lung disease.- Reflux aspiration in specific lung diseases.- The relationship between asthma and gastro-esophageal reflux.- Gastroesophageal reflux disease (GERD) and COPD.- Gastro oesophageal reflux and bronchiectasis.- Reflux aspiration and cystic fibrosis.- Gastro-oesophageal reflux and idiopathic pulmonary fibrosis.- Gastro-oesophageal reflux disease and chronic cough.- Reflux and aspiration: their presumed role in chronic cough and development of end-stage lung disease.- Reflux aspiration in specific circumstances.- Reflux and aspiration in the Intensive Care Unit.- Incidence and risk of aspiration in mechanically ventilated patients.- Reflux in paediatrics.- Aspiration in the elderly.- Therapy of airway reflux.- Acid suppression for management of gastroesophageal reflux disease; benefits and risks.- Reflux inhibitors and prokinetics.- Macrolides, reflux and respiratory disease.- Inhaled, nebulised and oral bronchodilators in reflux disease.- Speech therapy: reflux aspiration and lung diseases.- Anti reflux surgery.

Professor Alyn Morice was trained at Cambridge University with the clinical attachment at St George's Hospital, London. Having obtained his MRCP, he undertook research in asthma at St Mary's Hospital, London studying the clinical pharmacology of airway nerves. During this time, a patient presented with an unexplained cough which was the first observation of ACE inhibitor cough and subsequently led to the demonstration of the Cough Hypersensitivity Syndrome in a Lancet paper of 1987. Professor Morice was then appointed Lecturer in Clinical Pharmacology at Cambridge University and started a lifelong interest in cough challenge and its role in dissecting the physiology of airway nerves. Appointed as Senior Lecturer and then Reader at the University of Sheffield, Professor Morice continued to study both the in vitro and in vivo pharmacology of the airway and pulmonary nerves. He founded the first dedicated Cough Clinic in the United Kingdom, which continues to see over 400 new patients per annum and has a national referral pattern.

Professor Morice moved to Hull in 1998 to take up the Foundation Chair in Respiratory Medicine. The aetiology of chronic cough was established by the development of the Hull Airways Reflux Questionnaire; a validated instrument demonstrating that cough hypersensitivity is usually caused by aspiration of gaseous non acid reflux. The technique of high resolution oesophageal manometry has revolutionised our understanding of the pathophysiology basis of airway reflux.

No less than five new drugs are currently in development and being studied in our Clinical Trials Unit. The importance of reflux, aspiration and lung disease has reached a zenith.
Professor Peter Dettmar is the former global Research and Development Director - Gastrointestinals for Reckitt Benckiser Healthcare (UK) Limited with extensive experience in running product development programs and clinical trials and over thirty five years'