Comorbidity of bronchial asthma and esophageal pathology: Clinical and immunological characteristics

Introduction. The combination of esophageal pathology and bronchial asthma is frequently encountered in clinical practice, but in some cases it may remain unrecognized due to diagnostic difficulties and a lack of clinical suspicion.

Aim. To evaluate the structural, functional, and laboratory abnormalities detected in patients with bronchial asthma combined with esophageal pathology.

Materials and methods. The study was conducted at the Allergology Department of the Krasnoyarsk Regional Clinical Hospital. Sixty-nine patients admitted for inpatient treatment with a diagnosis of bronchial asthma were examined. Based on clinical and anamnestic data, the patients were divided into two groups: those with bronchial asthma without esophageal pathology (Group 1: 38 patients (55.07%)) and those with bronchial asthma combined with esophageal pathology (Group 2: 31 patients (44.93%)). The examination methods included: anamnestic analysis, physical examination, completion of the ACQ-5, ACT, GERDQ, and dysphagia questionnaires, instrumental tests (spirography with a bronchodilator, fibrogastroduodenoscopy), laboratory tests, and esophageal morphological examination.

Results. Patients with asthma combined with esophageal pathology had a significantly higher number of daytime and nighttime attacks and, consequently, a higher need for SABA. According to spirometry data, fixed airway obstruction was significantly more common among patients in Group 2. Immune status showed a significant decrease in NKT cells in Group 2 patients. A decrease in NKT cells in patients with bronchial asthma combined with esophageal pathology, as well as a negative association with fungal esophagitis, may indirectly indicate a decrease in epithelial barrier function and, consequently, a greater vulnerability to environmental factors, as also confirmed by the AQLQ questionnaire scores in the “environment” domain.

Conclusions. The obtained data confirm the aggravating effect of esophageal pathology on the course of bronchial asthma and also indirectly indicate changes in the mucosal immune system, which may lead to combined damage to the mucous membranes of the esophagus and respiratory tract.

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