Advertisement

Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 100–105 | Cite as

Idiopathic Pulmonary Fibrosis and Gastroesophageal Reflux. Implications for Treatment

  • Marco E. Allaix
  • Piero M. Fisichella
  • Imre Noth
  • Fernando A. Herbella
  • Bernardo Borraez Segura
  • Marco G. Patti
2013 SSAT Plenary Presentation

Abstract

Background

Even though the pathogenesis of idiopathic pulmonary fibrosis (IPF) is unknown, there is mounting evidence that abnormal reflux (GERD) and aspiration of gastric contents may play a role in the pathogenesis of this disease.

Aims

The aims of this study were to determine in patients with GERD and IPF: (a) the clinical presentation, (b) the esophageal function, and (c) the reflux profile.

Methods

We compared the clinical presentation, the esophageal function (as defined by high-resolution manometry), and the reflux profile (by dual sensor pH monitoring) in 80 patients with GERD (group A) and in 22 patients with GERD and IPF (group B).

Results

Heartburn was present in less than 60 % of patients with GERD and IPF. Lower esophageal sphincter pressure and peristalsis were normal in both groups, while the upper esophageal sphincter (UES) was more frequently hypotensive in IPF patients (p = 0.008). In patients with GERD and IPF, the proximal esophageal acid exposure was higher (p = 0.047) and the supine acid clearance was slower as compared with patients with GERD only (p < 0.001).

Conclusions

The results of this study show that in patients with GERD and IPF: (a) reflux is frequently silent, (b) with the exception of a weaker UES, the esophageal function is preserved, and (c) proximal reflux is more common, and in the supine position, it is coupled with a slower acid clearance. Because these factors predisposing IPF patients to the risk of aspiration, antireflux surgery should be considered early after the diagnosis of IPF and GERD is established.

Keywords

Idiopathic pulmonary fibrosis Gastroesophageal reflux disease Heartburn Esophageal manometry Ambulatory 24 h pH monitoring 

Notes

References

  1. 1.
    Lee JS, Collard HR, Raghu G, Sweet MP, Hays SR, Campos GM, Golden JA, King TE Jr. Does chronic microaspiration cause idiopathic pulmonary fibrosis? Am J Med 2010;123:304–311.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Raghu G, Weycker D, Edelsberg J, Bradford WZ, Oster G. Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2006;174:810–816.PubMedCrossRefGoogle Scholar
  3. 3.
    Raghu G, Brown KK, Bradford WZ, Starko K, Noble PW, Schwartz DA, King TE Jr; Idiopathic Pulmonary Fibrosis Study Group. A placebo-controlled trial of interferon gamma-1b in patients with idiopathic pulmonary fibrosis. N Engl J Med 2004; 350:125–133.PubMedCrossRefGoogle Scholar
  4. 4.
    Patti MG, Tedesco P, Golden J, Hays S, Hoopes C, Meneghetti A, Damani T, Way LW. Idiopathic pulmonary fibrosis: how often is it really idiopathic? J Gastrointest Surg 2005;9:1053–1056.PubMedCrossRefGoogle Scholar
  5. 5.
    Sweet MP, Patti MG, Leard LE, Golden JA, Hays SR, Hoopes C, Theodore PR. Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. J Thorac Cardiovasc Surg 2007;133:1078–1084.PubMedCrossRefGoogle Scholar
  6. 6.
    Raghu G, Meyer KC. Silent gastro-oesophageal reflux and microaspiration in IPF: mounting evidence for anti-reflux therapy? Eur. Respir J 2012;39:242–245.CrossRefGoogle Scholar
  7. 7.
    Linden PA, Gilbert RJ, Yeap BY, Boyle K, Deykin A, Jaklitsch MT, Sugarbaker DJ, Bueno R. Laparoscopic fundoplication in patients with end-stage lung disease awaiting transplantation. J Thorac Cardiovasc Surg 2006;131:438–446.PubMedCrossRefGoogle Scholar
  8. 8.
    Hoppo T, Jarido V, Pennathur A, Morrell M, Crespo M, Shigemura N, Bermudez C, Hunter JG, Toyoda Y, Pilewski J, Luketich JD, Jobe BA. Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg 2011;146:1041–1047.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee JS, Ryu JH, Elicker BM, Lydell CP, Jones KD, Wolters PJ, King TE Jr, Collard HR. Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis. Am. J Respir Crit Care Med 2011;184:1390–1394.PubMedCrossRefGoogle Scholar
  10. 10.
    Fouad YM, Katz PO, Hatlebakk, JG, Castell DO. Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms. Am J Gastroenterol 1999;94:1464–1467.PubMedCrossRefGoogle Scholar
  11. 11.
    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;87:1102–1111.PubMedGoogle Scholar
  12. 12.
    Patti MG, Debas HT, Pellegrini CA. Clinical and functional characterization of high gastroesophageal reflux. Am J Surg 1993;165:163–168.PubMedCrossRefGoogle Scholar
  13. 13.
    Raghu G, Freudenberger TD, Yang S, Curtis JR, Spada C, Hayes J, Sillery JK, Pope CE 2nd, Pellegrini CA. High prevalence of abnormal acid gastroesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J 2006;27:136 –142.PubMedCrossRefGoogle Scholar
  14. 14.
    Sweet MP, Herbella FA, Leard L, Hoopes C, Golden J, Hays S, Patti MG. The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation. Ann Surg 2006;244:491–497.PubMedGoogle Scholar
  15. 15.
    Salvioli B, Belmonte G, Stanghellini V, Baldi E, Fasano L, Pacilli AM, De Giorgio R, Barbara G, Bini L, Cogliandro R, Fabbri M, Corinaldesi R. Gastro-oesophageal reflux and interstitial lung disease. Dig Liver Dis. 2006;38:879–884.PubMedCrossRefGoogle Scholar
  16. 16.
    Gasper WJ, Sweet MP, Golden JA, Hoopes C, Leard LE, Kleinhenz ME, Hays SR, Patti MG. Lung transplantation in patients with connective tissue disorders and esophageal dysmotility. Dis Esophagus 2008;21:650–655.PubMedCrossRefGoogle Scholar
  17. 17.
    Horvath KD, Jobe BA, Herron DM, Swanstrom LL. Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 1999;3:583–591.PubMedCrossRefGoogle Scholar
  18. 18.
    Oleynikov D, Eubanks TR, Oelschlager BK, Pellegrini CA. Total fundoplication is the operation of choice for patients with gastroesophageal reflux and defective peristalsis. Surg Endosc 2002;16:909–913.PubMedCrossRefGoogle Scholar
  19. 19.
    Patti MG, Robinson T, Galvani C, Gorodner MV, Fisichella PM, Way LW. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg 2004;198:863–869.PubMedCrossRefGoogle Scholar
  20. 20.
    Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006; 20: 159–165.PubMedCrossRefGoogle Scholar
  21. 21.
    Booth MI, Stratford J, Jones L, Dehn TC. Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-oesophageal reflux disease based on preoperative oesophageal manometry. Br J Surg 2008;95:57–63.PubMedCrossRefGoogle Scholar
  22. 22.
    Broeders JAJL, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJ, Broeders IA, Hazebroek EJ. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 2010;97:1318–1330PubMedCrossRefGoogle Scholar
  23. 23.
    Herbella FAM, Tedesco P, Nipomnick I, Fisichella PM, Patt MG. Effect of partial and total laparoscopic fundoplication on esophageal body motility. Surg. Endosc 2007;21:285–288.PubMedCrossRefGoogle Scholar
  24. 24.
    Heider TR, Behrns KE, Koruda MJ, Shaheen NJ, Lucktong TA, Bradshaw B, Farrell TM. Fundoplication improves disordered esophageal motility. J Gastrointest Surg 2003;7:159–163.PubMedCrossRefGoogle Scholar
  25. 25.
    Bahmeriz F, Dutta S, Allen CJ, Pottruff CG, Anvari M. Does laparoscopic antireflux surgery prevent the occurrence of transient lower esophageal sphincter relaxation? Surg Endosc 2003;17:1050–1054.PubMedCrossRefGoogle Scholar
  26. 26.
    Kauer WK, Peters JH, DeMeester TR, Ireland AP, Bremner CG, Hagen JA. Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. Ann Surg 1995;22:525–533.Google Scholar
  27. 27.
    Tamhankar AP, Peters JH, Portale G, Hsieh CC, Hagen JA, Bremner CG, DeMeester TR. Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedance technology. J Gastrointest Surg 2004;8:888–896.CrossRefGoogle Scholar
  28. 28.
    Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicenter study using combined ambulatory impedance-pH monitoring. Gut 2006;55:1398–1402.PubMedCrossRefGoogle Scholar
  29. 29.
    Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 2006; 93:1483–1487.PubMedCrossRefGoogle Scholar
  30. 30.
    Bello B, Zoccali M, Gullo R, Allaix ME, Herbella FA, Gasparaitis A, Patti MG. Gastroesophageal reflux disease and antireflux surgery—what is the proper preoperative work-up? J Gastrointest Surg. 2013; 17:14–20 discussion p. 20PubMedCrossRefGoogle Scholar
  31. 31.
    Gasper WJ, Sweet MP, Hoopes C, Leard LE, Kleinhenz ME, Hays SR, Golden JA, Patti MG. Antireflux surgery for patients with end-stage lung disease before and after lung transplantation. Surg Endosc 2008;22:495–500.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Marco E. Allaix
    • 1
  • Piero M. Fisichella
    • 2
  • Imre Noth
    • 3
  • Fernando A. Herbella
    • 1
  • Bernardo Borraez Segura
    • 1
  • Marco G. Patti
    • 1
  1. 1.Center for Esophageal Diseases, Department of SurgeryUniversity of Chicago Pritzker School of MedicineChicagoUSA
  2. 2.Swallowing Center and Department of SurgeryLoyola University Chicago, Stritch School of MedicineChicagoUSA
  3. 3.Department of MedicineUniversity of Chicago Pritzker School of MedicineChicagoUSA

Personalised recommendations