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Increased GERD Risk in End-Stage Lung Disease Without Esophageal Disease

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End-stage lung disease (ESLD) may significantly increase the risk for gastroesophageal reflux disease (GERD) in patients undergoing lung transplant without primary esophageal disease, according to study results presented at the 2020 CHEST Annual Meeting, held virtually from October 18 to 21.

Researchers conducted a retrospective analysis to determine the association between GERD and ESLD in patients with normal levels of esophageal motility on high-resolution manometry (HRM). Using a database for esophageal disease, the researchers collected HRM information from patients undergoing lung transplant and those with normal HRM without hiatal hernia. Based on pulmonary function test results, patients were divided into 3 groups, including end-stage obstructive lung disease (OLD), end-stage restrictive lung disease (RLD), and normal spirometry. The HRM of all patients was re-evaluated for certain parameters, including lower esophageal sphincter (LES), distal contractile integral (DCI), adjusted thoracoabdominal pressure gradient (TAPGad), and minimum esophageal pressures 5 cm above LES during inspiration and expiration.

A total of 79 patients (OLD, 21; RLD, 21; normal spirometry, 37; 60.8% men; mean age, 60±14 years) were included in the study. Of the total cohort, 8 (38.1%), 12 (57.1%), and 8 (21.6%) of patients with OLD, RLD, and normal spirometry, respectively, had abnormal DeMeester scores (defined as >14.72).

Study results showed that RLD increased the risk for abnormal reflux (odds ratio [OR], 4.833; 95% CI, 1.506-15.511; P =.006), but OLD did not (OR, 2.232; 95% CI, 0.138-1.456; P =.177). Mean DeMeester scores in the OLD, RLD, and normal spirometry groups were and 16.7±17.3, 20.5±18.2, and 9.9±12.5, respectively. Researchers also noted abnormal DeMeester scores in 63.6% of patients with abnormal TAPGad (defined as ≥0), and therefore, increased risk for pathologic reflux (OR, 5.375; P =.001). Minimum esophageal pressures significant varied among the 3 groups during inspiration and expiration (P =.002 and P =.034, respectively).

Overall, compared with patients with normal spirometry, patients with end-stage RLD were found to be at significantly increased risk for pathologic reflux due to abnormal esophageal acid exposure, even in the absence of primary esophageal disease.

Researchers concluded, “More sensitive and specific diagnostic tools should be implemented for symptomatic and silent GERD assessment in patients with advanced pulmonary diseases.”

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Schedule7 Jun 2023