What Causes Bronchitis? Silent Acid Reflux!
- Unbeknownst to most people, acid reflux, usually Silent LPR, is the most common cause of chronic bronchitis (in non-smokers with no lung disease or exposure to environmental irritants). And although air pollution is often cited as a major cause of bronchitis, it isn’t; in my experience, pollution must be severe and prolonged to be a causative factor.
- Acute bronchitis can be caused by an upper respiratory infection; however without some other concomitant source of on-going inflammation like reflux, it is almost always self-limited, only lasting days to weeks.
- Respiratory reflux can cause, accelerate and/or complicate bronchitis, as well as most other respiratory and airway diseases (e.g., cystic fibrosis, COPD, subglottic stenosis).
- An illustrative case example is presented below, that of a businessman with chronic bronchitis complicated by hemoptysis (coughing up blood). Recognition that it was reflux resulted in definitive diagnosis, treatment and subsequent complete resolution, i.e., cure. The case also illustrates a familiar but unfortunate story, namely, that both patients and their doctors often do not recognize reflux as the underlying cause.
38-year-old businessman came to me with a four-year history of chronic bronchitis and cough. The cough was very disruptive and life-altering. It was a “wet,” productive cough. He was a lifetime non-smoking, non-drinker with no other risk factors for bronchitis. The patient was being seen at two major medical centers without benefit.
His other symptoms were hoarseness, post-nasal drip, chronic throat-clearing, a lump-in-the-throat sensation and difficulty swallowing and a few nights a week he awakened in the middle of the night with violent cough and gasping for air like a fish out of water. Note: All of those symptoms are respiratory reflux (LPR) symptoms. It is significant to add that the patient was also anemic. That’s because he also had hemoptysis; he was coughing up blood.
In my laboratory, he underwent specialized manometry testing that revealed that his upper and lower esophageal sphincters (UES, LES) were functioning poorly. In fact, his lower esophageal valve (LES) pressure was virtually zero. Reflux testing (ambulatory, 24-hour, double-probe pH monitoring) confirmed that he had severe reflux, with acid in his throat all night long.
TNE, Transnasal Esophagoscopy, was performed and showed that the LES was wide open and not functioning as an effective valve to prevent reflux; see below.
The first photograph shows a view of the wide-open LES valve from below and the second shows the gaping LES from above.
Because of the severity of the patient’s reflux disease and knowing that he was already on a a healthy diet and lifestyle, I sent him straightaway to a surgeon for an anti-reflux surgical procedure, called laparoscopic (Nissen) fundoplication. That is the only procedure that I recommend if a surgical procedure is needed; I almost never recommend the Linx, Stretta or Endocinch procedures, which are less effective and still associated with complications.
If You Fix Reflux, You Can Fix Bronchitis
Within three weeks of the surgery, the patient’s bronchitis and chronic cough dramatically improved AND by eight weeks post-op, he was well … no bronchitis, no hemoptysis, no cough. And at follow-up, two years later he remained well.
Conclusions: Take-Away Messages
- Silent respiratory reflux occurs at night and gastroenterologists have neither the knowledge nor resources to diagnose and treat it. Unfortunately, even ear nose and throat doctors who are able to examine the throat, often lack the necessary diagnostic expertise. Silent Reflux remains a huge “black hole” in the healthcare system.
- The aerodigestive tract—“aerodigestive” is a medical term for the respiratory and digestive systems as a single entity—has no physician. Over-specialization accounts for the fact that before seeing me, most of my patients have seen allergists, otolaryngologists, gastroenterologists and pulmonologists, none of whom could properly diagnose and treat the problem.
- A new field, Integrated Aerodigestive Medicine (YouTube Lecture), needs to become part of the curriculum in medical schools; and rather than training various medical specialists, in my opinion, this important “specialty” should fall under the domain of the primary care physician.
- #1 Take-Away: Respiratory reflux can cause or complicate most respiratory diseases. In addition, this is particularly so in people who worked at Ground Zero or in lower Manhattan after 9/11. There is good reason to believe that chronic bronchitis, COPD (chronic obstructive pulmonary disease), chronic cough, even lung cancer are related to respiratory reflux.
- Lung cancer, Too? The course of my career, I have seen approximately 100 patients with lung cancer and throat cancer with no significant exposure to tobacco or any other known carcinogen. Virtually every one was found to have LPR. I believe that you can get cancer without smoking but not without reflux; and even among smokers, it may be the reflux (pepsin) that tips the balance, that causes cancer.