The prevalence of gastro-esophageal reflux disease and esophageal dysmotility in Chinese patients with idiopathic pulmonary fibrosis.

BACKGROUND: The cause of idiopathic pulmonary fibrosis (IPF) remains unknown, yet gastro-esophageal reflux disease (GERD) is highly prevalent in this population. GERD prevalence was studied, and esophageal function tests (EFT) were assessed in Chinese IPF patients. METHODS: We prospectively studied 69 IPF patients who undertook both stationary High Resolution esophageal Manometry/Impedance (HRiM) and 24-hour esophageal Multi-Channel Intraluminal Impedance with pH Recordings (MII/pH). Patients were divided into GERD+ and GERD- groups according to pH results. Controls were HRiM treated healthy volunteers, and patients without IPF received HRiM and MII/pH diagnosed with GERD. RESULTS: 69 IPF patients, 62 healthy volunteers, and 88 IPF negative GERD patients were selected. GERD prevalence in IPF was 43/69 (62.3%), and 58.1% of patients presented with at least one typical symptom. Symptoms had a sensitivity of 58.1%, a specificity of 61.6%, a positive predictive value of 71.4% and a negative predictive of 47.1%. Compared with healthy volunteers, IPF patients had significantly decreased lower esophageal sphincter pressure (LESP), upper esophageal sphincter pressure (UESP) and complete bolus transit rate (CBTR). By contrast, IPF patients had increased total bolus transit time and prevalence of weak peristalsis. MII/pH showed that one third of IPF patients had abnormal distal and proximal reflux, especially non-acid reflux. Compared with GERD patients without IPF, GERD patients with IPF had significantly decreased CBTR and UESP with increased bolus exposure time. CONCLUSIONS: GERD prevalence in IPF was high, but symptoms alone were an unreliable predictor of reflux. IPF patients had lower LESP and UESP, impaired esophageal peristalsis and bolus clearance function with more proximal reflux events.

[A study of esophageal function and reflux characteristics of gastroesophageal reflux disease in patients presenting with chronic cough].

OBJECTIVE: To investigate the characteristics of gastroesophageal reflux disease (GERD) with chronic cough by the results of combined multichannel intraluminal impedance and high-resolution manometry (MII-HRM) procedure and 24-hour multichannel intraluminal impedance combined pH (MII-pH) monitoring. METHODS: From March 2010 to November 2010, consecutive patients of GERD with chronic cough (more than 8 weeks) admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability (SAP) over 95%. Data of lower esophageal sphincter (LES) pressure, LES relaxation, LES residual pressure, esophageal body peristalsis function and swallow bolus transit (liquid/viscous) was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity (acid/nonacid, upright/recumbent), proximal extent, acid exposure and mean acid/bolus clearance time. Seventeen patients of GERD with typical reflux symptom were selected as the control group. RESULTS: Comparing with patients of GERD with typical reflux symptom, patients of GERD with chronic cough showed decreased upper esophageal sphincter pressure (UESP) [(122.55 ± 60.48) mm Hg vs (86.37 ± 41.35) mm Hg, P < 0.05, 1 mm Hg = 0.133 kPa], higher percentage of abnormality peristalsis [(9.47 ± 15.63)% vs (22.16 ± 17.45)%, P < 0.05], degraded esophagus transmittability of liquid substance [(88.82 ± 12.23)% vs (71.68 ± 23.06)%, P < 0.05], more reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position (P < 0.05) and longer mean bolus clearance time (P < 0.05). CONCLUSION: Decrease of the UESP, increase of the reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position, lengthened mean bolus clearance time in supine position and the degraded esophagus clearance ability may all correlated with the pathogenesy of GERD with chronic cough.

[The relationship between gastroesophageal reflux disease and idiopathic pulmonary interstitial fibrosis].

OBJECTIVE: To determine the prevalence of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary interstitial fibrosis (IPIF). METHODS: From December 2006 to January 2008, 24 consecutive patients with IPIF admitted to Beijing Chaoyang Hospital underwent 24-hour esophageal pH monitoring and esophageal manometry. Meanwhile, 23 patients with diffuse parenchymal lung disease (DPLD) (excluding IPIF) admitted to the hospital in the same period served as a control group. Comparison of the prevalence of pathologic esophageal acid exposure GERD symptoms, and ineffective esophageal motility (IEM) between the two groups was made. In this study, nocturnal acid exposure is defined as acid reflux episodes occurring from 10pm to 6am. RESULTS: (1) 16 out of the 24 (66.7%) patients with IPIF were demonstrated to have pathologic esophageal acid exposure; the prevalence of GERD in IPIF patients was significantly higher than that in other DPLD patients, whose prevalence was 26.1% (P < 0.05) ; (2) 87.5% patients with IPIF and GERD (GERD-IPIF) had nocturnal acid exposure episodes; (3) only 37.5% of the GERD-IPIF patients was found to have typical GERD symptoms such as heartburn and regurgitation; (4) The prevalence of IEM was similar in IPIF and other DPLD patients, being 42.9% and 39.1% respectively (P > 0.05). CONCLUSIONS: IPIF patients have higher prevalence of GERD and most of them usually do not show typical reflux symptoms. It is hereby suggested that IPIF patients should be screened with pH monitoring for GERD.