Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation
Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation
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DOI：
10.1016/j.jtcvs.2006.09.085
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发表时间：
2007-04-01
影响因子：
6
通讯作者：
Theodore, Pierre R.
中科院分区：
文献类型：
--
作者：
Sweet, Matthew P.;Patti, Marco G.;Theodore, Pierre R.
目的：胃食管反流病与特发性肺纤维化之间的关联尚未完全确定。本研究的目的是确定特发性肺纤维化患者的（1）反流症状的患病率，（2）食管测压曲线，以及（3）近端和远端食管反流的患病率。方法：1999年5月至2006年3月期间，30名特发性肺纤维化患者被转诊至加州大学旧金山分校吞咽中心。每名患者均接受结构化症状评估、食管测压和 24 小时双传感器动态 pH 监测。结果：20 名 (67%) 患者出现食管反流异常。典型的反流症状虽然在反流患者中更为常见，但作为筛查测试并不可靠（敏感性 65%，特异性 71%）。百分之六十五的反流异常患者患有食管下端括约肌血压过低。食管蠕动异常在反流患者中更为常见（50% vs 10%；P = .03）。在 9 名 (30%) 患者中，胃酸反流至近端食管的时间超过研究时间的 1%。结论：大多数特发性肺纤维化患者存在病理性反流。症状并不能区分是否存在反流。在这些患者中，反流与食管下端括约肌血压低和食管蠕动异常有关，并且经常延伸到近端食管。
Objectives: The association between gastroesophageal reflux disease and idiopathic pulmonary fibrosis has not been fully characterized. The aims of this study were to determine in patients with idiopathic pulmonary fibrosis ( 1) the prevalence of reflux symptoms, ( 2) the esophageal manometric profile, and ( 3) the prevalence of proximal and distal esophageal reflux.Methods: Between May 1999 and March 2006, 30 patients with idiopathic pulmonary fibrosis were referred to the Swallowing Center at the University of California San Francisco. Each patient underwent a structured symptom assessment, esophageal manometry, and 24-hour dual sensor ambulatory pH monitoring.Results: Twenty (67%) patients had abnormal esophageal reflux. Typical reflux symptoms, although more common in those with reflux, were not reliable as a screening test ( sensitivity 65%, specificity 71%). Sixty-five percent of patients with abnormal reflux had a hypotensive lower esophageal sphincter. Abnormal esophageal peristalsis was more common among those with reflux (50% vs 10%; P = .03). In 9 (30%) patients, acid refluxed into the proximal esophagus for over 1% of the study time.Conclusions: A majority of patients with idiopathic pulmonary fibrosis have pathologic reflux. Symptoms do not distinguish between those with and without reflux. In these patients, reflux is associated with a hypotensive lower esophageal sphincter and abnormal esophageal peristalsis, and often extends into the proximal esophagus.