Gastroesophageal Reflux and Pulmonary Fibrosis in Scleroderma

Savarino, Edoardo; Bazzica, Marco; Zentilin, Patrizia; Pohl, Daniel; Parodi, A. Ferretto; Cittadini, Giuseppe; Negrini, Simone; Indiveri, Francesco; Tutuian, Radu; Savarino, Vincenzo; Ghio, Massimo

doi:10.1164/rccm.200808-1359oc

Cited by 254 publications

(151 citation statements)

References 54 publications

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“…The prevalence defined by maximal diameter (Dmax) was consistently higher than carinal diameter (Dcar), indicating maximal diameter is more sensitive but less specific criteria for esophageal dilation. Accumulating evidence suggests an important role of esophageal dysfunction in the development of lung disease in systemic sclerosis or other lung diseases (el-Serag and Sonnenberg 1997;Tobin et al 1998;Marie et al 2001;Savarino et al 2009;Christmann et al 2010;Patiwetwitoon et al 2012). In this study, we found a correlation between esophageal parameters and pulmonary function tests in systemic sclerosis patients.…”

Section: Discussionsupporting

confidence: 62%

“…It has been suggested that esophageal dysfunction and aspiration may play a role in pathogenesis of interstitial lung disease in systemic sclerosis and other lung diseases (el-Serag and Sonnenberg 1997; Tobin et al 1998;Marie et al 2001;Savarino et al 2009;Christmann et al 2010). Esophageal dilation on CT scan correlates well with esophageal dysfunction (Pitrez et al 2006;Vonk et al 2008).…”

Section: Introductionmentioning

confidence: 99%

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Computed Tomography of the Esophagus in Scleroderma and Lung Disease

Takekoshi

Arami

Sheppard

et al. 2015

Tohoku J. Exp. Med.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Computed Tomography of the Esophagus in Scleroderma and Lung Disease

Takekoshi

Arami

Sheppard

et al. 2015

Tohoku J. Exp. Med.

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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%

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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“…Similarly, in an earlier pathophysiological study in a group of scleroderma patients with various degrees of pulmonary fibrosis based on high resolution computed tomography, not only acid but also weakly acidic refluxes were found much higher in patients with more severe than in those with mild or moderate pulmonary fibrosis. 10 In conclusion, we would like to emphasize that reflux monitoring plays a fundamental role in confirming the presence of GERD in IPF patients and, therefore, the benefit of PPI use in them should be evaluated in carefully investigated subjects in order to provide stronger evidence that PPI may be helpful for their wellbeing and survival.…”

Section: To the Editormentioning

confidence: 97%