Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation

Sweet, Matthew P.; Patti, Marco G.; Leard, Lorriana E.; Golden, Jeffrey A.; Hays, Steven R.; Hoopes, Charles W.; Theodore, Pierre

doi:10.1016/j.jtcvs.2006.09.085

Cited by 141 publications

(116 citation statements)

References 20 publications

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“…Recent studies of patients with idiopathic pulmonary fibrosis and who were lung transplant candidates have shown that reflux is related to both alterations. (23) This dual manometric alteration might be related to the severity of the pulmonary profile, which is much greater in this type of terminal pulmonary disease patient than in those included in other studies. (20,22) In this regard, the failure of two of the principal mechanisms of the antireflux barrier (LES and peristalsis), allowing the ascension of the refluxed material and its permanence in the esophagus for a long time, can, together, contribute results were abnormal in 44%, including 50 (35.2%) of the asthma patients who presented no digestive symptoms.…”

Section: Resultsmentioning

confidence: 68%

Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifestações respiratórias

et al. 2008

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Objective: To determine the prevalence of gastroesophageal reflux disease (GERD) and to evaluate the esophageal motor profile of patients with respiratory symptoms referred to a digestive motility referral center for esophageal function testing. Methods: The results of esophageal manometry and 24-h esophageal pH-metry were analyzed. The inclusion criterion was presenting respiratory symptoms, with or without accompanying digestive symptoms. Results: Of the 1,170 patients included in the study, 602 (51.5%) reported having digestive and respiratory symptoms (DRS group), and 568 (48.5%) reported having only respiratory symptoms (RS group). Asthma was diagnosed in 142 patients in the RS group (RS-A subgroup) and in 201 of those in the DRS group (DRS-A subgroup). Of the 346 cases of esophageal dysmotility, hypomotility was found in 175 (14.3% and 15.6% in the DRS and RS groups, respectively), and lower esophageal sphincter (LES) hypotonia was found in 411 (40.3% and 30.2%, respectively). Hypotonia correlated with GERD. Exposure of the distal esophagus to acid was markedly abnormal in the supine position. The prevalence of GERD in the sample as a whole, the RS-A/DRS-A subgroups and the RS-A subgroup alone was 39.8%, 44.0% and 35.2%, respectively. Conclusions: Hypotonic LES was the most common abnormality and correlated with GERD. Although GERD was more evident in the DRS group, approximately one third of the patients in the RS group also presented GERD (silent GERD). The findings suggest that GERD can be an extrapulmonary cause of chronic respiratory symptoms unresponsive to conventional therapy.Keywords: Gastroesophageal reflux; Signs and symptoms, respiratory; Asthma; Esophageal pH monitoring; Manometry. ResumoObjetivo: Determinar a prevalência da doença do refluxo gastroesofágico (DRGE) e avaliar o perfil motor esofágico de portadores de manifestações respiratórias encaminhados para avaliação funcional esofágica em um serviço de referência em motilidade digestiva. Métodos: Foram analisados os resultados de esofagomanometria e de pHmetria esofágica de 24 h. O critério de inclusão foi a presença de sintomas respiratórios, acompanhados ou não de sintomas digestivos. Resultados: Dos 1.170 pacientes incluídos no estudo, 602 (51,5%) relataram manifestações digestivas associadas às respiratórias (grupo MRD) e 568 (48,5%), apenas respiratórias (grupo MR). A asma foi diagnosticada em 142 indivíduos no grupo MR (subgrupo MR-A) e em 201 no grupo MRD (subgrupo MRD-A). Dentre os 346 casos de dismotilidade do corpo esofágico, a hipomotilidade esteve presente em 175 (14,3% e 15,6%, respectivamente, no grupos MRD e MR) e hipotonia do esfíncter esofágico inferior (EEI) em 411 (40.3% e 30,2% nos mesmos grupos, respectivamente). A hipotonia se correlacionou com DRGE. A exposição do esôfago distal ao ácido foi marcadamente anormal no período de decúbito. A prevalência de DRGE na amostra total, nos subgrupos MR-A/MRD-A e somente no subgrupo MR-A foi de 39,8%, 44,0% e 35,2%, respectivamente. Conclusões: A hipotonia do EEI foi a ...

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Section: Resultsmentioning

confidence: 68%

Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifestações respiratórias

et al. 2008

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“…However in non IPF patients, they didn't find any significant correlation between the severity of GER and the degree of lung fibrosis, which indicated that more damage and excessive fibrosis occurred in IPF diagnosed patients having more severe GER. However, Sweet et al [7] illustrated that 25-65% was the range of the GER symptoms in their patients. They detected that the specificity of the presence of actual GER pathology was 71% for their patients.…”

Section: Resultsmentioning

confidence: 86%

“…In many researches, it was detected that heartburn, regurgitation and dysphagia as common symptoms of GER aren't detected in many IPF patients. So, screening of abnormal GER in IPF patients by using the symptoms only is not appropriate method [7]. There is no accurate diagnostic testing for microaspiration and GER as declared by many researches.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

Said¹,

Alsowey²,

Ibraheem³

2017

Zagazig University Medical Journal

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Background: Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause.Recently, there is increasing evidence supporting a relationship between gastroesophageal reflux, microaspiration, and IPF, since the diagnostic gold-standard for microaspiration remains unknown. So, the aim of this study is to assess the presence of chronic microaspirates by bronchoalveolar lavage pepsin level in these patients. Patients and method: A case -control study was conducted at Chest Department and outpatient clinics Faculty of Medicine, Zagazig University hospitals in the period from (February 2013 till January 2016) on thirty patients with stable interstitial lung diseases (ILD).they were divided into two groups: 15 patients (group I) with stable idiopathic pulmonary fibrosis (IPF), another 15 patients (group II) stable ILD other than IPF. Both groups underwent pulmonary function tests (PFTs), Pulmonary HRCT and Bronchoscopy. Measurement of bronchoalveolar lavage pepsin level was done for all patients. Results: 80% of IPF patients complained from gastroesophageal reflux with a statistically significant decrease in PaO 2 , FEV 1 and FVC than in non IPF patients.Bronchoalveolar lavage pepsin level was (43.711.4ng/ml) in IPF group, which was significantly higher than non IPF group (32.710.5 ng/ml).Also total cell count in IPF patients were increased significantly including neutrophils, alveolar macrophages and red blood. Increased reticulation on HRCT for IPF patients group were associated with higher BAL pepsin levels (p <0.01). Regression coefficient revealed the most powerful predictor of IPF severity were; HRCT findings: reticulation score,honeycombing score[(Odds ratio(95%CI)=5.3 (1.9 to14.9), 7.8 (2.7 to 22.3)respectively],pepsin level[(Odds ratio(95%CI)=4.6 (1.9-11.4)],FEV1 and FVC[(Odds ratio(95%CI)=3.7 (1.6 to 8.9), 3.2 (1.4 to 7.5)respectively].while gastroesophageal reflux symptom [(Odds ratio(95%CI)=1.04(0.94-1.14)] was the least powerful predictor. Conclusion: Gastroesophageal reflux or microaspiration is common in patients with IPF, associated with elevated levels of pepsin in BAL fluid.

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“…Similar to scleroderma, patients with IPF have a high prevalence of GERD [12,65,[73][74][75], leading to the hypothesis that recurrent occult microaspiration may drive the ongoing inflammation characteristic of this disease. This should not be confused with acute exacerbation of IPF (progression of symptoms over weeks with radiographic airspace disease), as biopsies may also reveal organising pneumonia with underlying UIP in this syndrome [76,77].…”

Section: Ipfmentioning

confidence: 99%

Gastro-oesophageal reflux disease and non-asthma lung disease

Morehead¹

2009

European Respiratory Review

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Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection.Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures.Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail.Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

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Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation

Cited by 141 publications

References 20 publications

Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifestações respiratórias

Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifestações respiratórias

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

Gastro-oesophageal reflux disease and non-asthma lung disease

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