Esophageal involvement and interstitial lung disease in mixed connective tissue disease

Fagundes, M.N.; Caleiro, Maria Teresa Correia; Navarro–Rodriguez, Tomás; Baldi, Bruno Guedes; Kavakama, Jorge; Salge, João Marcos; Kairalla, Ronaldo Adib; Carvalho, Carlos Roberto Ribeiro

doi:10.1016/j.rmed.2008.12.018

Cited by 60 publications

(35 citation statements)

References 32 publications

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“…GERD is also frequent in patients with CTD. Studies with 24-hour pH with and without impedance monitoring demonstrated abnormal reflux in 83% to 50% (8,9,24) of patients. A negative impact of abnormal reflux in the pulmonary function has been demonstrated.…”

Section: Connective Tissue Disordersmentioning

confidence: 95%

“…In our study, absence of peristalsis was also linked to more severe reflux. Fagundes et al (8) studied 50 patients with mixed connective tissue disease and correlated esophageal dilation seen on high resolution CT scan with the presence of ILD. The prevalence of ILD in patients with esophageal dilation was 92%, compared with 45% in patients without esophageal dilation.…”

Section: Does Impairment In the Esophageal Motility Have Influence Onmentioning

confidence: 99%

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Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Soares

Forsythe

Hogarth

et al. 2011

Arq. Gastroenterol.

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-Context -Gastroesophageal reflux disease (GERD) is common in patients with respiratory disorders and interstitial lung fibrosis from diverse disease processes. However, a cause-effect relationship has not been well demonstrated. It is hypothesized that there might be more than a coincidental association between GERD and interstitial lung damage. There is still confusion about the diagnostic steps necessary to confirm the presence of GERD, and about the role of effective control of GERD in the natural history of these respiratory disorders. Objectives -To determine the prevalence of GERD in patients with respiratory disorders and lung involvement; the sensitivity of symptoms in the diagnosis of GERD; and the role of esophageal function tests (manometry and 24-hour pH monitoring) in the diagnosis and treatment of these patients. Methods -Prospective study based on a database of 44 patients (29 females) with respiratory disorders: 16 patients had idiopathic pulmonary fibrosis, 11 patients had systemic sclerosis associated interstitial lung disease, 2 patients had polymyositis associated interstitial lung disease, 2 patients had Sjögren associated interstitial lung disease, 2 patients had rheumatoid artrithis associated interstitial lung disease, 1 patient had undifferentiated connective tissue diseases associated interstitial lung disease and 10 patients had sarcoidosis. The average forced vital capacity (% predicted) was 64.3%. All patients had esophageal function tests. Results -Thirty patients (68%) had pathologic reflux (average DeMeester score: 45, normal <14.7). The average number of reflux episodes recorded 20 cm above the lower esophageal sphincter was 24. Sensitivity and specificity of heartburn were 70% and 57%, of regurgitation 43% and 57%, and of dysphagia 33% and 64%. Twelve patients with GERD underwent a laparoscopic fundoplication which was tailored to the manometric profile: three patients in which peristalsis was normal had a total fundoplication (360°) and nine patients in which the peristalsis was absent had a partial anterior fundoplication (180°). Conclusions -The results of our study show that: (a) abnormal reflux was present in about 2/3 of patients with respiratory disorders (idiophatic pulmonary fibrosis, connective tissue disorders and sarcoidosis), and it extended to the upper esophagus in most patients; (b) the sensitivity and specificity of reflux symptoms was very low; and (c) esophageal function tests were essential to establish the diagnosis of abnormal reflux, to characterize the esophageal function and guide therapy. Long term follow-up will be necessary to determine if control of reflux alters the natural history of these respiratory disorders.

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Section: Connective Tissue Disordersmentioning

confidence: 95%

Section: Does Impairment In the Esophageal Motility Have Influence Onmentioning

confidence: 99%

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Soares

Forsythe

Hogarth

et al. 2011

Arq. Gastroenterol.

View full text Add to dashboard Cite

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“…Moreover, patients with mixed connective tissue disease (MCTD) will likely suffer from ILD at some time (3), and these patients often have original features of SSc or develop SSc (4). Typically, the onset of SSc-ILD is insidious, with subtle clinical symptoms, which may explain why SSc-ILD is often diagnosed at an advanced stage, after extensive lung fibrosis is already present (5).…”

Section: Introductionmentioning

confidence: 99%

Serum KL-6 and surfactant protein-D as monitoring and predictive markers of interstitial lung disease in patients with systemic sclerosis and mixed connective tissue disease

Yamakawa¹,

Hagiwara²,

Kitamura³

et al. 2017

J. Thorac. Dis.

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“…In most studies of IPF, the clinical manifestations presented by the patients were not sufficient to distinguish patients with pathological GER from those without it, since approximately half of the patients do not report typical symptoms, such as heartburn or regurgitation. (5)(6)(7)9,28,29) In the present study, 77.7% of the patients with pathological GER presented at least one typical symptom. Cough, the most common extraesophageal respiratory symptom of GERD, (19) is present in most patients, regardless of the presence of GERD.…”

Section: Discussionmentioning

confidence: 45%

“…These findings are recognized as the most common abnormalities associated with respiratory symptoms and inefficacious esophageal motility in GERD, constituting some of the factors that make acid clearance difficult, and this favors GER. (19) In a study of patients with mixed connective tissue disease, (28) the occurrence of HRCT findings of interstitial lung disease was significantly greater among the patients with esophageal dilation and among those with severe esophageal motor dysfunction. One group of authors, (29) evaluating lung transplant candidates with advanced lung disease, found that the prevalence of abnormal manometry results was high (76%) and that the number of patients in the present study is small, greatly limiting the scope of the conclusions regarding the true prevalence of GERD in this population.…”

Section: Discussionmentioning

confidence: 97%

Prevalência da doença do refluxo gastroesofágico em pacientes com fibrose pulmonar idiopática

et al. 2009

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Objective: To determine the prevalence of gastroesophageal reflux disease (GERD) and to evaluate its clinical presentation, as well as the esophageal function profile in patients with idiopathic pulmonary fibrosis (IPF). Methods: In this prospective study, 28 consecutive patients with IPF underwent stationary esophageal manometry, 24-h esophageal pH-metry and pulmonary function tests. All patients also completed a symptom and quality of life in GERD questionnaire. Results: In the study sample, the prevalence of GERD was 35.7%. The patients were then divided into two groups: GERD+ (abnormal pH-metry; n = 10) and GERD− (normal pH-metry; n = 18). In the GERD+ group, 77.7% of the patients presented at least one typical GERD symptom. The pH-metry results showed that 8 (80%) of the GERD+ group patients had abnormal supine reflux, and that the reflux was exclusively in the supine position in 5 (50%). In the GERD+ and GERD− groups, respectively, 5 (50.0%) and 7 (38.8%) of the patients presented a hypotensive lower esophageal sphincter, 7 (70.0%) and 10 (55.5%), respectively, presenting lower esophageal dysmotility. There were no significant differences between the groups regarding demographic characteristics, pulmonary function, clinical presentation or manometric findings. Conclusions: The prevalence of GERD in the patients with IPF was high. However, the clinical and functional characteristics did not differ between the patients with GERD and those without.Keywords: Pulmonary fibrosis; Gastroesophageal reflux; Prevalence; Manometry; Esophageal pH monitoring. ResumoObjetivo: Determinar a prevalência da doença do refluxo gastroesofágico (DRGE) e sua apresentação clínica, além do perfil funcional do esôfago em pacientes com fibrose pulmonar idiopática (FPI). Métodos: Foram avaliados prospectivamente 28 pacientes com FPI. Os pacientes foram submetidos à esofagomanometria estacionária, pHmetria de 24 h e testes de função pulmonar, assim como responderam a questionários sobre sintomas e qualidade de vida em DRGE. Resultados: A prevalência de DRGE foi de 35,7%. Os pacientes foram divididos em dois grupos: grupo DRGE+ (pHmetria anormal; n = 10), e grupo DRGE− (pHmetria normal; n = 18). No grupo DRGE+, 77,7% dos pacientes apresentavam pelo menos um sintoma típico de DRGE. Nesse grupo de pacientes, 8 (80%) apresentaram refluxo em posição supina, e 5 (50%) apresentaram refluxo exclusivamente nessa posição. Nos grupos DRGE+ e DRGE−, respectivamente, 5 (50,0%) e 7 (38,8%) dos pacientes apresentaram hipotonia do esfíncter esofágico inferior, assim como 7 (70,0%) e 10 (55,5%) apresentaram hipomotilidade esofágica. Não houve diferenças significativas entre os grupos quanto a características demográficas, função pulmonar, apresentação clínica ou achados manométricos. Conclusões: A prevalência de DRGE nos pacientes com FPI foi elevada. Entretanto, as características clínicas e funcionais não diferiram significativamente entre os pacientes com e sem DRGE.Descritores: Fibrose pulmonar; Refluxo gastroesofágico; Prevalência; Manome...

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Esophageal involvement and interstitial lung disease in mixed connective tissue disease

Abstract: Although we were not able to prove a causal relationship between esophageal and pulmonary involvement, our series revealed a strong association between esophageal motor dysfunction and interstitial lung disease in patients with mixed connective tissue disease.

Cited by 60 publications

References 32 publications

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Serum KL-6 and surfactant protein-D as monitoring and predictive markers of interstitial lung disease in patients with systemic sclerosis and mixed connective tissue disease

Prevalência da doença do refluxo gastroesofágico em pacientes com fibrose pulmonar idiopática

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