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Idiopathic Pulmonary Fibrosis: How Often Is It Really Idiopathic?
Pietro Tedesco, Jeffrey Golden, Steven Hays, Charles Hoopes, Adam T. Meneghetti, Tanuja Damani, Marco G. Patti, UCSF Medical Center, San Francisco, CA

Background:
It has been suggested that some patients with idiopathic pulmonary fibrosis (IPF) have gastroesophageal reflux disease (GERD). GERD can be involved in the pathogenesis of the disease and can damage the transplanted lung.

Aims:
The aims of this study were to determine in patients with IPF: (a) the incidence of GERD; (b) the clinical presentation; (c) the manometric and reflux profile.

Patients and Methods:
Between July 2003 and October 2004, 18 patients with IPF on the lung transplant list were referred for evaluation to the Swallowing Center of the University of California at San Francisco.

Results:
Based on the results of the 24-hour pH monitoring, patients were divided into two groups: Group A, 12 patients (66%), GERD+; Group B, 6 patients (34%), GERD-:


D=distal; P=proximal. LES= Lower Esophageal Sphincter

Conclusions:
The results of this study show that: (a) sixty-six per cent of patients with IPF had abnormal reflux by 24-hour pH monitoring; (b) symptoms did not distinguish between patients with and without GERD and 1/3 of them were asymptomatic; (c) reflux was due to a hypotensive lower esophageal sphincter and abnormal peristalsis; (d) reflux occurred in both the upright and supine position and extended all the way to the pharynx. These data suggest that every patient with IPF should be screened for GERD and that a fundoplication should be considered before or immediately after a lung transplant.


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