115: The Pulmonary Sequelae of Gastro-Oesophageal Reflux Disease

Abstract

Background and aim Gastro-oesophageal reflux disease (GORD) and a spectrum of pulmonary diseases, including idiopathic pulmonary fibrosis (IPF) and bronchiectasis have a complex but poorly understood relationship. IPF is characterised by chronic progressive interstitial pneumonia due to the deposition of fibrous tissue in the pulmonary interstitium. It has a median survival time from diagnosis of 2 to 5 years. Bronchiectasis is defined as irreversible dilatation of the bronchial tree, leading to severe pulmonary infections and gradual deterioration in lung function. Chronic micro aspiration of acid and non-acid refluxate leading to airway irritation, repeated lung injury and respiratory tree remodelling has been implicated in the pathophysiology and progression of both diseases. Current studies have shown that patients with severe GORD will demonstrate pulmonary aspiration of refluxate on scintigraphic scanning. We aim to demonstrate the presence of pulmonary aspiration of refluxate on oesophageal scintigraphy and correlate this with changes of fibrosis, scarring, bronchiectatic and ground glass changes on high resolution computed tomography (HRCT) chest imaging. Methods Retrospective data was obtained from 114 patients who underwent oesophageal scintigraphy reflux studies at a single nuclear medicine imaging facility to evaluate for significant GORD or extra-oesophageal symptoms. Scintigraphy results were then compared with HRCT chest studies of the respective patients. Lobar locations of parenchymal changes on CT were correlated with location of isotope in lungs seen during aspiration on scintigraphy. Results 114 of patients demonstrated evidence of pulmonary aspiration on scintigraphy in the delayed study. All patients had intermittent or continuous full column gastro-oesophageal reflux with evidence of tracer in both lungs or the right lung. Of these patients, 35 underwent HRCT chest studies. 23 of the 35 patients had evidence of pulmonary disease on HRCT, demonstrated by fibrosis, scarring, bronchiectatic changes or ground glass opacities. 11 patients showed evidence of pulmonary fibrosis or scarring, and 10 of these demonstrated co-location of pulmonary aspiration on scintigraphy. 10 of 11 patients with bronchiectactic change were co-located with pulmonary aspiration. Conclusion These results demonstrate a likely relationship between GORD, IPF and bronchiectasis, indicating that the current clinical paradigm of GORD and respiratory disease being two separate entities must be re-evaluated.