Correlations Between Exhaled Nitric Oxide Levels And Esophageal PH Monitoring In Asthma And Gastroesophageal Reflux Disease

ObjectiveTo study the fractional exhaled nitric oxide (FeNO) levels in patients with bronchial asthma, gastroesophageal reflux disease (GERD) and asthmatics with gastroesophageal reflux at different times and different degrees. At the same time, we detect pulmonary function, differential count, the percentage of differential count and 24-hour esophageal pH monitoring. To discuss the diagnostic value of FeNO concentration as a method of asthma and gastroesophageal reflux disease in non-invasive means of monitoring and the relations between it and pulmonary function, differential count, the percentage of differential count, 24-hour esophageal pH monitoring.MethodsTo select 16 cases of patients with bronchial asthma, 20 cases of patients with gastroesophageal reflux disease and 16 cases of patients with gastroesophageal reflux of asthmatics in hospital from March 2010 to February 2011. To detect the exhaled nitric oxide, at the same time, to determine pulmonary function, differential count, the percentage of differential count, 24-hour esophageal pH measurement involve the percentage of study time with pH <4, the number of episodes with pH <4, the number of episodes >5 min with pH< 4 and DeMeester score. Compared FeNO levels between the three groups and the relationship with the indicators. Results1. Compared the level of FeNO, differential count, the percentage of differential count of the three groups of patients, to be found that FeNO,EOS,EOS% were existing overall differences. We also found that FeNO, EOS, EOS% were increased at asthma and asthmatics with gastroesophageal reflux than gastroesophageal reflux disease(P <0.05-0.01). The level of FeNO in asthma patients were higher than asthmatics with gastroesophageal reflux, statistical significant differences were existing ( P <0.05). While there was no obvious difference of EOS, EOS% between the two groups. There was no signifcant difference in indexes of pulmonary function among the three groups .2. There was an obvious correlation between concentration of FeNO and EOS, EOS% in asthma (P<0.05). However, there was no significant correlation between FeNO and EOS of the gastroesophageal reflux disease and asthmatics with gastroesophageal reflux.3. There was an obvious correlation between concentration of FeNO and the percentage of study time with pH <4, the number of episodes with pH <4, the number of episodes >5 min with pH< 4 and DeMeester score at the gastroesophageal reflux disease and asthmatics with gastroesophageal reflux (P all<0.01), but there was an correlation between concentration of FeNO and the outcome of pH monitoring.Conclusions1. These findings sensitively indicated a role for FeNO in the eosinophilic airway Inflammation. FeNO levels increased much at asthma and asthmatics with gastroesophageal reflux than gastroesophageal reflux disease. There was a positive correlation between FeNO and EOS, it prompted that FeNO mainly reflect the level of eosinophilic air-way inflammation.2. Inhalation of acid gastric contents may affect diversification FeNO in asthmatics with gastroesophageal reflux. On the one hand, acid gastric contents into the airways may directly interfere with the generation and/or release of NO or directly damage the NO-producing cells within the airways.On the other hand,it may lead to asthmatic attack again and again and increase the EOS,EOS%.The diphasic action induce the raise of FeNO.Therefor, we concluded that the increase of FeNO reflect the severity of acid reflux partly in asthmatics with gastroesophageal reflux.3. The level of FeNO was significant for diagnose of asthma and asthmatics with gastroesophageal reflux, it also can be used to differential diagnosis of gastroesophageal reflux disease and asthmatics with gastroesophageal reflux.