Constrictive bronchiolitis presenting with a mixed obstructive and restrictive pattern, associated with acid reflux

Abstract

A previously healthy 55-year-old woman presented with worsening dyspnoea on exertion. The patient lived at altitude, did not smoke and had no exposure to occupational or environmental toxins. Her physical examination, including pulmonary, was unremarkable. Pulmonary function tests showed forced expiratory volume in 1 s/forced vital capacity ratio 74% predicted, diffusing capacity for carbon monoxide (DLCO) 92% predicted and residual volume 213% predicted. Rheumatological workup was negative. Chest radiograph showed hyperinflation without consolidation, and high-resolution chest CT showed mosaic attenuation with air trapping on expiratory imaging. A decreasing DLCO lead to transbronchial biopsies that were inconclusive. A video-assisted thoracic surgery lung biopsy showed small airway disease suggestive of constrictive bronchiolitis. Oesophagram and a barium swallow showed a hiatal hernia with large volume gastro-oesophageal reflux to the level of the clavicles. The development of constrictive bronchiolitis in this patient was possibly secondary to hiatal hernia and silent gastroesophageal reflux disease (GERD). In the face of presumably idiopathic lung disease, clinicians should perform a GERD workup even in the absence of GERD symptoms.

Idiopathic Obliterative Bronchiolitis in a Young Woman: A Rare Case of a Transbronchial Lung Biopsy Contributing to the Diagnosis

“…Several studies have described the association of gastro-esophageal reflux disease (GERD) and BOS after lung transplantation ( 8 , 9 ). Capel et al reported a case of a non- transplant OB patient with a large volume of gastro-esophageal reflux and considered GERD to be associated with the development of OB ( 10 ). They also suggested that GERD might account for some of the cases of idiopathic OB.…”

Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs

“…Likewise, the BAL fluid profiles in dogs with sHH and GERD warrant additional investigation because GERD has been implicated in the pathogenesis and progression of respiratory diseases such as asthma, bronchiolitis, interstitial pulmonary fibrosis, and chronic obstructive pulmonary disease in people. [37][38][39][40] Unfortunately, underutilization of BAL fluid in dogs in our study precluded evaluation of the effect of GERD on BAL fluid cytology in dogs.…”