Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease

The relation between respiratory disorders and reflux symptoms has been debated since the beginning of the last century and the interest in the question has increased during the last few decades. This study aims to investigate the relation between specified respiratory disorders and reflux symptoms and examine the correlation between respiratory disorders and endoscopic findings in patients with gastroesophageal reflux disease. This study included 515 patients evaluated for gastroesophageal reflux disease [GERD] by patient self-report symptom questionnaire; modified four grade Likert scale and endoscopic assessment using endoscopic Los Angeles Classification. All participants were asked about various respiratory symptoms experienced during the past six months and exposed to measuring body mass index [BMI], medical history, pulmonary physical examination, chest X-ray, respiratory function tests and available sleep studies. A total number of 515 patients were categorized according to endoscopic findings into two groups; [group 1] subjects with normal endoscopic studies [NERD] 118 [22.9%] patients and [group 2] subjects with abnormal endoscopic studies [ERD] 397 [77.1%]. The proportion of females was significantly higher in ERD group [80.1%] as compared with NERD group [62.7%] [P<0.02]. Duration of reflux symptoms found to be significantly prolonged in ERD group [P<0.03]. The cases of ERD group were more likely to be overweight [BMI>25] P<0.02. History of pulmonary symptoms preceding GERD symptoms was found in 15% of patients. There were 294 patients [57.1%] with different pulmonary manifestations. These manifestations were significantly higher among female group [P<0.01] and among obese, above 40 years old [P<0.001, 0.05 respectively]. Among all patients with respiratory manifestations the commonest disorders diagnosed were chronic pharyngitis [50.3%], chronic bronchitis [15.8%], bronchial asthma [12.6%] and recurrent pneumonia [3.3%]. Obstructive sleep apnea and recurrent hemoptysis were present in 2.7% and 1.5% of the studied patients respectively. There were three cases of chronic lung abscess. There was a significant difference between ERD and NERD groups in their relations to respiratory disorders [P<0.001]. There were statistically significant differences in FEV1,FVC and FEV1/FVD [P<0.02, P<0.05 and P<0.05] respectively in ERD group as compared with NERD group. The study confirms the strong link between gastroesophageal reflux symptoms and various respiratory disorders. Endoscopy of the upper digestive tract remains an important exam in the evaluation of GERD. Respiratory symptoms are more prevalent among erosive esophagitis patients with a positive correlation with degree of severity. These is direct relationship between the severity of airways obstruction as detected by FEV[1], and FEV1/FVC and GER symptoms

Cardiopulmonary compromise during and after gastrointestinal endoscopy

Although gastrointestinal endoscopy is a safe procedure, it is occasionally associated with complications especially in elderly patients or those having heart disease. We studied some cardiopulmonary parameters during and after upper gastrointestinal endoscopy and colonoscopy in patients with and without heart disease in different age groups. Ninety hospitalized patients with age range [46-94 years]; all underwent endoscopy without premedications or conscious sedation. Patients were classified into three groups according to age and risk cardiac index. Electrocardiography with two leads [II, V5] was used; blood pressure and peripheral oxygen saturation [SpO2] were monitored throughout the procedure. Troponin t was evaluated before and 12 hours after the procedure. Relation between changes in cardiopulmonary parameters during and after endoscopy and cardiac function were analyzed. A significant fall was noted in SpO2 during the procedure in group II [92.12 +/- 3.4] and group III [91. 75 +/- 2.4] [P= 0.001] whereas in group I [95 .34 +/- 1.1] no significant fall in SpO2 was noted from the baseline [P=0.63]. A higher cardiac risk index was found in patients with oxygen desaturation than in patients without it [P<0.05]. Atrial and ventricular premature beats found to be significantly higher in old patients and those had underlying heart disease. There is significant increase in systolic blood pressure during insertion of endoscope in all groups with no statistical difference between groups [P=0.5]. ST changes were recorded in three patients with no significant ST level changes between patients with and without heart diseases. Silent ischemia was reported as elevated Troponin t in three patients. Duration of the procedure significantly correlated with oxygen desaturation. Transient cardiopulmonary changes are not uncommon during upper and lower gastrointestinal endoscopy. Patients with ischemic heart disease, chronic pulmonary disease, advanced age, and those undergoing prolonged therapeutic procedures must be considered as high risk patients for the development of cardiopulmonary complications during gastrointestinal endoscopy. Routine use of electronic monitoring with pulse oximetry, ECG recording and blood pressure are important for detecting potentially important abnormalities in high risk groups