TABLE 3.

Studies of gastro-oesophageal reflux treatment in cystic fibrosis and bronchiectasis

First author [ref] Study type	n	Treatment	CF symptoms	Exacerbations	FEV1	Other outcomes
Cystic fibrosis
Malfroot [134] Prospective observational	16	Cisapride therapy	Improved weight gain and improved cough and wheeze	N/A	N/A	N/A
Brodzicki [135] Prospective observational	19	Cisapride or cisparide with ranitidine for 3 months	N/A	N/A	N/A	Improved GORD outcomes on pH analysis: decrease in reflux index, longest episode duration and the no. of episodes >5 min; improvement of endoscopic picture post-treatment
van der Doef [123] Prospective observational	218	Gastric acid inhibition (proton pump inhibitors or histamine-2 receptor antagonists) for fat malabsorption or GORD	N/A	N/A	GORD was associated with significantly reduced FEV1 and FVC Patients with gastric acid inhibition had a significantly smaller yearly decline of MEF50 and MEF25–75%	GORD was associated with an earlier acquisition of P. aeruginosa and S. aureus
Tran [136] Children Prospective observational	15	Lansoprazole 15 mg daily for 3 months	Improved faecal steatorrhoea	N/A	N/A	Significant improvements in fat mass nutritional status and bone mineral content
Hendriks [137] Prospective observational	14	Lansoprazole 30 mg daily for 1 year	Improved faecal steatorrheoa	N/A	Improved TLC, RV and inspiratory muscle capacity	Improved BMI, decreased fat losses and improved total body fat
Dimango [138] RCT	17	PPI (esomeprazole 40 mg BD) for 36 weeks	N/A	Trend to earlier exacerbation and more frequent exacerbations in esomeprazole group	FEV1 unchanged	No change in Gastroesophageal Symptom Assessment Score or CF Quality of Life score between the two groups
Zeybel [133] Prospective observational	12	Ivacaftor (CF patients with G511D mutations)	N/A	N/A	Baseline FEV1 lower in patients with extra-oesophageal reflux symptoms	Improved extra-oesophageal reflux symptoms using the Reflux Symptom Index and the Hull Airways Reflux Questionnaire
Boesch [139] Children Prospective observational	25	Nissen fundoplication	N/A	N/A	No change in FEV1 or body mass index after fundoplication; children who had an FEV1 <60% predicted at time surgery had significantly improved FEV1 compared to those with FEV1 <60%	No mortality associated with fundoplication, but 12% had complications that required a subsequent surgical procedure
Fathi [145] Prospective observational	6	Nissen fundoplication	N/A	50% reduction in exacerbations 2 years post-operatively	Small but significant improvement in FEV1 and FVC 2 years post-operatively	Improved cough symptoms using the Leicester Cough Questionnaire
Sheikh [146] Retrospective observational		Nissen fundoplication	Increased weight gain	Fewer pulmonary exacerbations	Slower decline in FEV1 2 years post-operatively	Better pulmonary and nutritional outcomes were noted among patients with milder lung disease compared to those with severe lung disease; no mortality associated with surgery
Bronchiectasis
Ahn [159] Prospective observational	257	PPI therapy (any type) for 6 months	N/A	N/A	Unchanged Subgroup analyses showed significant improvement in lung function in patients with high BMI related to the severity of obesity	N/A
Hu [160] Prospective observational	7	Stretta radiofrequency (SRF) n=2 Laparoscopic fundoplication with or without hiatal hernia repair n=4 Combined n=1	Improved	Improved exacerbations Improved hospitalisations	N/A	Improved GORD symptoms

Abbreviations: CF: cystic fibrosis; FEV₁: forced expiratory volume in 1 s; GORD: gastro-oesophageal reflux; FVC: forced vital capacity; MEF₅₀: maximal expiratory flow at 50 % of FVC; MEF_25–75%: mean expiratory flow at 25–75% of FVC; TLC: total lung capacity; RV: residual volume; BMI: body mass index; RCT: randomised controlled trial; PPI: proton pump inhibitor.