Effect of Proton Pump Inhibitors in Bronchiectatic Patients with Gastroesophageal Reflux Disease / 대한소화기학회지

BACKGROUND/AIMS: Bronchiectasis is aggravated by gastroesophageal reflux disease (GERD) owing to micro aspiration. Some researchers note the effect of antireflux surgery in bronchiectasis with GERD. However, few have investigated the effects of medical antireflux therapy. We investigated the effect of proton pump inhibitors (PPIs) in bronchiectasis with GERD. METHODS: From March 2003 to May 2015, the clinical records of patients who had bronchiectasis with GERD were reviewed. Patients underwent an initial pulmonary function test (PFT) and chest computed tomography when diagnosed with bronchiectasis. One group with typical GERD symptoms was treated with PPIs, while the other group was not. Both groups underwent PFTs within six months after completing PPI therapy. Population characteristics and associations were compared between the groups. RESULTS: Two hundred and fifty-seven patients (124 male, 133 female; mean age 67.6±10.0 years) were included. There were no significant differences between the groups in terms of forced vital capacity (FVC; p=0.239), forced expiratory volume in one second (FEV1; p=0.555), or FEV1/FVC (p=0.374) after PPI therapy. However, there were significant improvements in FVC (p=0.002) and FEV1 (p=0.006) in patients with high BMI in the PPI treatment group. CONCLUSIONS: PPIs have no effect on the pulmonary function in patients with bronchiectasis and GERD. However, PPIs were noted to produce improvements in lung function in patients with bronchiectasis and high BMI.

Proton Pump Inhibitor-responsive Esophageal Eosinophilia: An Overview of Cases from One University Hospital Center / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, with eosinophilic infiltration limited to the esophagus. A minority of EoE patients respond well to proton pump inhibitor (PPI) therapy alone, and that condition is labelled PPI-responsive esophageal eosinophilia (PPI-REE). The prevalence of PPI-REE among EoE cases is unknown. We aimed to identify clinical manifestations of PPI-REE, and the proportion of PPI-REE among all EoE cases. METHODS: We reviewed pathology of the 4,075 patients who underwent esophageal biopsy at an institution from March 2003 to July 2015. EoE was diagnosed based on esophageal symptoms and eosinophilic infiltration limited to the esophagus, with ≥15 eosinophils per high-power field. We collected endoscopic and pathologic findings, and clinical features for these patients. RESULTS: Thirteen (0.3%) patients were diagnosed with EoE. Clinical manifestations were dysphagia (30.8%), foreign body sensation (23.1%), regurgitation (23.1%), cough (15.4%), heartburn (15.4%), nausea (7.7%), dyspepsia (7.7%). The endoscopic findings noted were polypoid lesion (23.1%), whitish plaque or exudate (23.1%), linear furrow (7.7%), concentric ring (7.7%), nodularity (7.7%), erosion (7.7%), and normal (30.8%). Of these patients, five had a favorable course with PPI as monotherapy. CONCLUSIONS: The proportion of EoE among all patients undergoing endoscopic biopsy was 0.3%. Of those, PPI-REE comprised 38%. Most of the endoscopic findings were atypical or normal when compared to the typical findings in EoE. In conclusion, patients who present with symptoms related to esophageal dysfunction need esophageal biopsy, regardless of the endoscopic findings. Moreover, patients diagnosed with EoE need to be treated first with PPI alone.