Abstract
Background
Gastroesophageal reflux disease (GERD) is known to be associated with many forms of respiratory diseases, including asthma, pulmonary fibrosis, cystic fibrosis, and obstructive sleep apnea syndrome. It is frequently coexistent, and may be causative or may exacerbate pre-existing lung disease. The main purpose of this study was to assess the effects of GERD on spirometry, lung diffusion, and impulse oscillometry.
Patients and methods
This study included 48 consecutive newly endoscopically diagnosed GERD patients with no pulmonary symptoms or previous smoking history who attended the Gastrointestinal Clinic at Ain Shams Hospital and Misr University for Science and Technology with complaints of reflux symptoms. Spirometry, lung diffusion, and oscillometry were performed in all included patients.
Results
There were statistically significant differences between cases with different grades of reflux as regards age. Most of the patients were included within grade B GERD with the highest mean age being 46.33±11.51. However, there was no significant difference as regards sex. There were statistically significant differences between cases with different grades of reflux as regards forced expiratory volume at the first second/forced vital capacity, maximum expiratory flow 25–75, and diffusing capacity of the lung for carbon monoxide (DLCO), but there was a highly statistically significant difference regarding residual volume/total lung capacity and residual volume. The grade of reflux was the only independent factor affecting DLCO, and grade B patients showed lower DLCO compared with grade A patients. There was a statistically significant positive correlation between grades of reflux and forced expiratory volume at the first second/forced vital capacity, maximum expiratory flow 25–75, and maximum mid-expiratory flow/peak expiratory flow, and a statistically significant negative correlation between grades of reflux and R20. There was a negative correlation between grades of reflux and DLCO, but it was not significant.
Conclusion
GERD severity is associated with impairment of gas exchange (DLCO) and central airway affection (R20) on impulse oscillometry. This may be due to microaspiration of gastric acid or fluid into the airways.
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References
Marco G, Katz J. Gastroesophageal reflux disease. Medscape 2014.
Ing AJ, Ngu MC, Breslin AB. Obstructive sleep apnea and gastro-esophageal reflux. Am J Med 2000;108:120S–125S.
Harding SM. Gastroesophageal reflux:a potential asthma trigger.Immunol Allergy Clin North Am 2005;25(1):131–148.
Harding SM. Gastroesophageal reflux and asthma: insight into the association. J Allergy Clin Immunol 1999;104(Pt 1):251–259.
Wiener GJ, Tsukashima R, Kelly C, Wolf E, Schmeltzer M, Bankert C et al. Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux. J Voice 2009;23(4):498–504.
Ford AC, Forman D, Moayyedi P, Morice AH. Cough in the community: a cross sectional survey and the relationship to gastrointestinal symptoms. Thorax 2006;61(11):975–979.
Nordenstedt H, Nilsson M, Johansson S, Wallander MA, Johnsen R, Hveem K et al. The relation between gastroesophageal reflux and respiratory symptoms in a population-based study: the Nord-Trøndelag Health Survey. Chest 2006;129:1051–1056.
Farrell S, McMaster C, Gibson D, Shields MD, McCallion WA. Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration. J Pediatr Surg 2006;41(2):289–293.
Colombo JL, Hallberg TK. Airway reactivity following repeated milk aspiration in rabbits. Pediatr Pulmonol 2000;29(2):113–119.
Lazenby JP, Guzzo MR, Harding SM, Patterson PE, Johnson LF, Bradley LA. Oral corticosteroids increase esophageal acid contact times in patients with stable asthma. Chest 2002;121(2):625–634.
Irwin RS, Madison JM. The persistently troublesome cough. Am J Respir Crit Care Med 2002;165(11):1469–1474.
Allen CJ, Anvari M.Preoperative symptom evaluation and esophageal acid infusion predict response to laparoscopic Nissen fundoplication in gastroesophageal reflux patients who present with cough. Surg Endosc 2002;16(7):1037–1041.
Field SK, Underwood M, Brant R, Cowie RL. Prevalence of gastroesophageal reflux symptoms in asthma. Chest 1996;109(2):316–322.
Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med 2000;162(1):34–39.
Mokhlesi B, Morris AL, Huang CF, Curcio AJ, Barrett TA, Kamp DW. Increased prevalence of gastroesophageal reflux symptoms in patients with COPD. Chest 2001;119(4):1043–1048.
Tobin RW, Pope CE 2nd, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998;158(6):1804–1808.
Mays EE, Dubois JJ, Hamilton GB. Pulmonary fibrosis associated with tracheobronchial aspiration. A study of the frequency of hiatal hernia and gastroesophageal reflux in interstitial pulmonary fibrosis of obscure etiology. Chest 1976;69(4):512–515.
Mukhopadhyay S, Katzenstein AL. Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens. Am J Surg Pathol 2007;31:752–759.
de Carvalho ME, Kairalla RA, Capelozzi VL, Deheinzelin D, do Nascimento Saldiva PH, de Carvalho CR. Centrilobular fibrosis: a novel histological pattern of idiopathic interstitial pneumonia. Pathol Res Pract 2002;198 (9):577–583.
Phua SY, McGarvey LP, Ngu MC, Ing AJ. Patients with gastro-oesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity. Thorax 2005;60(6):488–491.
Frei J, Jutla J, Kramer G, Hatzakis GE, Ducharme FM, Davis GM. Impulse oscillometry: reference values in children 100 to 150 cm in height and 3 to 10 years of age. Chest 2005;128(3):1266–1273.
Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45 (2):172–180.
Vigneri S, Termini R, Leandro G, Badalamenti S, Pantalena M, Savarino V et al. A comparison of five maintenance therapies for reflux esophagitis. N Engl J Med 1995;333(17):1106–1110.
Jamieson Jr, Stein HJ, DeMeester TR, Bonavina L, Schwizer W, Hinder RA, Albertucci M. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol 1992;87(9):1102–1111.
Roca J, Rodriguez-Roisin R, Cobo E, Burgos F, Perez J, Clausen JL. Single-breath carbon monoxide diffusing capacity prediction equations from a Mediterranean population. Am Rev Respir Dis 1990;141(Pt 1):1026–1032.
Anvari M, Allen C, Moran LA. Immediate and delayed effects of laparoscopic Nissen fundoplication on pulmonary function. Surg Endosc 1996;10(12):1171–1175.
Schachter LM, Dixon J, Pierce RJ, O’Brien P. Severe gastroesophageal reflux is associated with reduced carbon monoxide diffusing capacity. Chest 2003;123(6):1932–1938.
Hunt JF, Fang K, Malik R, Snyder A, Malhotra N, Platts-Mills TA, Gaston B. Endogenous airway acidification. Implications for asthma pathophysiology. Am J Respir Crit Care Med 2000;161(Pt 1):694–699.
Kanda S, Fujimoto K, Komatsu Y, Yasuo M, Hanaoka M, Kubo K. Evaluation of respiratory impedance in asthma and COPD by an impulse oscillation system. Intern Med 2010;49(1):23–30.
Evans TM, Rundell KW, Beck KC, Levine AM, Baumann JM. Impulse oscillometry is sensitive to bronchoconstriction after eucapnic voluntary hyperventilation or exercise. J Asthma 2006;43:49–55.
Evans TM, Rundell KW, Beck KC, Levine AM, Baumann JM. Airway narrowing measured by spirometry and impulse oscillometry following room temperature and cold temperature exercise. Chest 2005;128 (4):2412–2419.
Bidad K, Heidarnazhad H, Kazemnejad A, Pourpak Z. Impulse oscillometry in comparison to spirometry in pregnant asthmatic females. Eur Respir J 2008;32(6):1673–1675.
Gube M, Brand P, Conventz A, Ebel J, Goeen T, Holzinger K et al. Spirometry, impulse oscillometry and capnovolumetry in welders and healthy male subjects. Respir Med 2009;103(9):1350–1357.
Eidani E, Hashemi SJ, Raji H, Hosaini Askarabadi M. A comparison of impulse oscillometry and spirometry values in patients with gastroesophageal reflux disease. Middle East J Dig Dis 2013;5(1):22–28.
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Ali, E.R., Abdelhamid, H.M. & Shalaby, H. Effect of gastroesophageal reflux disease on spirometry, lung diffusion, and impulse oscillometry. Egypt J Bronchol 10, 189–196 (2016). https://doi.org/10.4103/1687-8426.184368
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DOI: https://doi.org/10.4103/1687-8426.184368