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Pathophysiology of Gastroesophageal Reflux in Patients With Chronic Pulmonary Obstructive Disease Is Linked to an Increased Transdiaphragmatic Pressure Gradient Not a Defective Esophagogastric Barrier
Leonardo M. Del Grande1, Fernando a. Herbella*1, Marco G. Patti2
1Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil; 2Department of Surgery, University of Chicago, Chicago, IL
Introduction: The association of gastroesophageal reflux disease (GERD) and pulmonary diseases is well known. Chronic pulmonary obstructive disease (COPD) is probably the main pulmonary disease that lacks a satisfactory number of studies dealing with evaluation of esophageal motility and objective evaluation of acid exposure by esophageal function tests. This study aims to evaluate in patients with COPD: (1) esophageal motility; (2) thoracic and abdominal pressures, and (3) incidence of GERD diagnosed by ambulatory pH monitoring.
Methods: We studied 48 patients (56% females, age 66 years). All patients underwent a high resolution manometry and esophageal pH monitoring. Patients were group according to the presence of GERD based on a DeMeester score >14.7.
Results: GERD + comprised 21 (44%) patients (57% males, age 67 years). GERD - comprised 27 (56%) patients (33% males, age 65). There was no difference between groups in regard to gender (p=0.1), age (0.5), body mass index (p=0.8), and COPD severity (p =0.9). Manometric parameters are depicted in table 1. Thoracic pressure was lower in GERD + patients with a higher transdiaphragmatic pressure gradient and lower LES retention pressure (LES basal pressure -transdiaphragmatic gradient) in this group.
Conclusions: Our results show that: (1) almost half of COPD patients have GERD on pH monitoring, and (2) esophageal motility is not different in COPD GERD + and COPD GERD -. COPD patients have a higher incidence of GERD whose physiopathology is linked to an increased transdiaphragmatic pressure gradient not a defective esophagogastric barrier.
Manometric parameters
| Manometric parameter | GERD + (n=21) | GERD - (n=27) | p | | LES basal pressure (mmHg) | 20±10 | 22±10 | 0.5 | | hypotonic LES (%) | 19 | 22 | 1 | | hypertonic LES (%) | 0 | 0 | 1 | | Mean wave amplitude at 3 cm (mmHg) | 62±42 | 69±29 | 0.5 | | Mean wave amplitude at 7 cm (mmHg) | 67±38 | 77±38 | 0.4 | | Abdominal pressure (mmHg) | 11±5 | 10±4 | 0.6 | | Thoracic pressure (mmHg) | 0.8±6 | 5±6 | 0.02 * | | Transdiaphragmatic gradient (abdominal pressure - thoracic pressure) | 10±7 | 5±4 | 0.001 * | | LES retention pressure (LES basal pressure -transdiaphragmatic gradient) | 10±10 | 18±11 | 0.01 * |
LES: lower esophageal sphincter * statistic significance
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