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

Abstract

-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.

Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review

“…The prevalence of abnormal GER was reported in 23 studies [4,10,26,27,48,75,79,80,[101][102][103][104][105][106][107][108][109][110][111][112][113][114][115] (online supplementary table S6) and ranged from 0 among 20 IPF patients in Ireland who were participating in a study exploring the degree and mechanisms of sleep-disordered breathing, and for whom no history of GER was noted [80], to 94.1% in an analysis of consecutive, newly diagnosed IPF patients recruited from a single US centre [112] (figure 6). However, the 94% prevalence was based on a 24-h ambulatory physiological definition of abnormal acid GER: a most sensitive method of ascertaining abnormal acid GER that included abnormal acid exposure in the distal and/or proximal oesophagus.…”

Protective Effect of Proton Pump Inhibitor for Survival in Patients with Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis

“…[1][2][3] In particular, many studies have reported the higher prevalence of GERD in IPF. [4][5][6][7][8][9][10][11][12][13] The prevalence of GERD in patients with IPF was reportedly 67 to 88% in Western populations, [8][9][10]12,13 and 62.3% (43 of 69 patients) in China. 6 Although the mechanism is unclear, chronic microaspiration due to GERD has been considered to be one of the causes of IPF through repeated subclinical injury to the lungs.…”

Computed Tomography of the Esophagus in Scleroderma and Lung Disease

“…Esophageal dysfunction in patients with systemic sclerosis or other lung diseases is seldom detected at early stage (Ing 2001;Raghu 2003;Gaude 2009;Christmann et al 2010;Soares et al 2011), probably because reflux disease is often clinically silent (Raghu 2003) and diagnostic tests such as manometry, pH and impedance monitoring, endoscopy, and scintigraphy, are invasive or not routinely performed in everyday practice. Using CT scan measurements has several advantages in assessing esophageal dysfunction over the conventional methods.…”