The role of bronchoscopy in the diagnosis of patients with сhronic obstructive pulmonary disease and gastroesophageal reflux disease.

Abstract

Introduction. Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD) are frequently associated conditions, each potentially exacerbating the other. Literature data indicate that the prevalence of GERD in patients with COPD ranges from 17% to 78%, depending on the diagnostic method used. Bronchoscopy and bronchoalveolar lavage (BAL) provide valuable information, alongside other essential investigations, for assessing the impact of GERD on COPD.
Materials and Methods. A literature review was conducted using the PubMed, Scopus, Google Scholar, and HINARI databases, employing keywords such as “GERD,” “COPD,” “bronchoscopy,” “bronchoalveolar lavage (BAL),” and “diagnosis,” covering publications from 2017 to 2025.
Results. Flexible bronchoscopy revealed hyperemia, edema, and bronchial remodeling, with mucopurulent secretions in patients with COPD and GERD. Cytologically, BAL showed increased neutrophils and eosinophils; immunocytologically, a decreased CD4/CD8 ratio and the presence of B lymphocytes and NK cells were observed; markers of gastroesophageal microaspiration such as pepsin, gastrin, bile acids, IL-6, IL-8, TNF-α, and NO were also detected. Literature data indicate that testing for H. pylori is associated with inflammation and irritation of the esophageal and bronchial mucosa, findings also evident in BAL, contributing to COPD severity and the presence of GERD.
Conclusions. Bronchoscopy and BAL are essential tools for evaluating patients with COPD and GERD, providing direct or indirect evidence of gastroesophageal reflux microaspiration. These findings enable personalized patient management, reduction of exacerbations, and improvement in quality of life.