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Prevalence of Gastroesophageal Reflux in Chronic Obstructive Pulmonary Disease Patients
Henrique Abrahao1, Fernando a. Herbella*1, Amilcar M. Bigatao2, Jose R. Jardim2, Luciana C. Silva1, Fernando P. Vicentine1, Marco G. Patti3
1Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil; 2Department of Medicine, Division of Pneumology, Federal University of Sao Paulo, Sao Paulo, Brazil; 3Department of Surgery, University of Chicago, Chicago, IL
Background :The association of gastroesophageal reflux disease (GERD) and chronic pulmonary disorders has been a topic of great interest recently. However, little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). This study aims to evaluate in patients with COPD: (a) the prevalence and the sensitivity of symptoms to diagnose GERD; (b) the pattern of esophageal motility; and (c) the prevalence of distal and proximal GERD.
Methods: A total of 50 patients with DPOC (as defined by age > 40 years with a FEV1/FVC below 88% of the predicted value after bronchodilator use, and no prior history of asthma) underwent symptomatic assessment, high-resolution manometry and dual probe esophageal pH monitoring. GERD was defined by a DeMeester score >14.7. Proximal reflux was defined by >= 1 episode of proximal reflux.
Results: GERD was present in 21 (42%) of the total patients. GERD symptoms were referred by 20 (40%) patients more than once a month. Symptoms were not predictive of the presence of GERD (sensitivity 71%; specificity 83%). GERD symptoms presence, esophageal manometry and pHmonitoring according to the presence of distal GERD by pHmonitoring results are depicted in table 1.
Conclusions: These data show that in patients with DPOC: 1) GERD is present in almost half of the patients; 2) symptoms were insensitive and nonspecific for diagnosing GERD; 3) a defective LES is not more common in patients with GERD leading to the hypothesis that the physiopathology for GERD may be linked to the transthoracic pressure gradient in this population; 4) in 95% of the patients with GERD, acid refluxed into the proximal esophagus. We conclude that patients with DPOC should be screened with pH monitoring for GERD.
| GERD + (n=21) | GERD - (n=29) | p | | GERD symptoms | 15 (71%) | 5 (17%) | <0.001 | | hypotensive LES | 8 (39%) | 5 (17%) | 0.1 | | Abnormal peristalsis | 2 (9%) | 8 (28%) | 0.1 | | Abnormal amplitude | 10 (48%) | 4 (14%) | 0.01 | | Proximal GERD | 20 (95%) | 7 (24%) | <0.001 |
GERD: gastroesophageal reflux disease LES: lower esophageal sphincter
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