Gastroesophageal Reflux Disease in Patients with Idiopathic Pulmonary Fibrosis Awaiting Lung Transplantation
Back to 86th Annual Meeting
Back to Program Outline
Objective: The association between gastroesophageal reflux disease (GERD) and end-stage idiopathic pulmonary fibrosis (IPF) has not been fully elucidated. Furthermore, patients with documented GERD undergoing lung transplantation have accelerated graft failure and decreased mid-term survival. The aims of this study were to determine in patients with end-stage IPF awaiting lung transplantation: (a) the prevalence of GERD; (b) the clinical presentation of GERD; and (c) the manometric and reflux profiles.
Methods: Between July 2003 and October 2005, 100 consecutive patients prior to transplantation were referred for comprehensive swallowing and reflux evaluation. Of these, 28 patients carried the diagnosis IPF based on radiographic or biopsy criteria. Esophageal manometry and pH monitoring at 5 and 20 cm above the lower esophageal sphincter (LES) were performed.
Results: Based on Demeester score (normal <14.7), patients were divided into 2 groups: 22 patients (79%) with reflux (GERD+), and 6 patients (21%) without reflux (GERD-). The prevalence of heartburn did not differ between GERD+ patients and GERD- patients (p=.52). In 50% (11/22)of the GERD+ patients, reflux was associated with a hypotensive LES (<14mm Hg). GERD- patients had significantly higher mean resting LES pressures when compared to the GERD+ patients (25mm Hg versus 15mm Hg; p=.02). 36% of GERD+ patients were observed to have abnormal esophageal peristalsis. In 45% of GERD+ patients, acid reflux extended to the proximal esophagus.
Conclusions: In our series, the majority of IPF patients referred for lung transplantation have pathologic reflux as determined by 24-hour pH studies and manometry; however, symptoms do not distinguish between those with and without pathologic reflux. In these patients reflux is associated with a hypotensive LES, abnormal esophageal peristalsis and often extends into the proximal esophagus. Given the implied role of GERD in worsened outcomes post-transplantation we conclude that patients with IPF should be systematically screened for GERD. The role of esophageal fundoplication and the contribution of delayed gastric emptying on reflux remain to be determined.
Back to 86th Annual Meeting
Back to Program Outline
