Reflux-Aspiration in Chronic Lung Disease.
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ABSTRACT:
SUBMITTER: de Benedictis FM
PROVIDER: S-EPMC7393788 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
Reflux-Aspiration in Chronic Lung Disease.
de Benedictis Fernando M FM Guidi Roberto R Bush Andrew A
Annals of the American Thoracic Society 20200801 8
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Project description:BackgroundSalivary bile acids are used to diagnose extraesophageal reflux (EER) and to evaluate the risk of reflux aspiration that is associated with respiratory diseases in dogs.ObjectivesTo study total bile acid (TBA) concentrations in saliva and in bronchoalveolar lavage fluid (BALF) to investigate EER and reflux aspiration in dogs with respiratory diseases and in healthy dogs.Animals Thirty-one West Highland White Terriers (WHWTs) with idiopathic pulmonary fibrosis (IPF), 12 dogs with inflammatory airway disease (IAD), 6 dogs with recurrent pneumonia (RP), 26 brachycephalic dogs (BD), 27 healthy WHWTs (HW), 52 healthy dogs (HD). All privately-owned dogs.MethodsSaliva and BALF were collected from dogs in each group.ResultsSalivary TBA concentrations were higher in IPF (median 0.1692 μM, interquartile range [IQR] 0.1115-0.2925 μM, Cohen's d 3.4, 95% confidence interval [CI] 2.2-4.0, P < .001) and BD (0.0256 μM, IQR 0.0086-0.0417 μM, d 0.5, CI -0.1 to 1.1, P = .003) compared to HD (0 μM, IQR not quantifiable [n.q.]-0.0131 μM). Bronchoalveolar lavage fluid TBA concentrations were higher in IPF (0.0117 μM, IQR 0.0048-0.0361 μM, d 0.5, CI 0-1.1, P < .001) compared to HD (0 μM, IQR n.q.-0.0074 μM).Conclusion and clinical importanceExtraesophageal reflux and reflux aspiration occur in healthy dogs and those with respiratory diseases.
| S-EPMC9889628 | biostudies-literature
Project description:BackgroundGastroesophageal reflux and microaspiration (MA) of gastric juice are associated with various human respiratory diseases but not in dogs.ObjectiveTo detect the presence of bile acids in bronchoalveolar lavage fluid (BALF) of dogs with various respiratory diseases.AnimalsTwenty-seven West Highland White Terriers (WHWTs) with canine idiopathic pulmonary fibrosis (CIPF), 11 dogs with bacterial pneumonia (BP), 13 with chronic bronchitis (CB), 9 with eosinophilic bronchopneumopathy (EBP), 19 with laryngeal dysfunction (LD), 8 Irish Wolfhounds (IWHs) with previous BPs, 13 healthy WHWTs, all privately owned dogs, and 6 healthy research colony Beagles METHODS: Prospective cross-sectional observational study with convenience sampling of dogs. Bile acids were measured by mass spectrometry in BALF samples. Total bile acid (TBA) concentration was calculated as a sum of 17 different bile acids.ResultsConcentrations of TBA were above the limit of quantification in 78% of CIPF, 45% of BP, 62% of CB, 44% of EBP, 68% of LD, and 13% of IWH dogs. In healthy dogs, bile acids were detected less commonly in Beagles (0/6) than in healthy WHWTs (10/13). Concentrations of TBA were significantly higher in CIPF (median 0.013 μM, range not quantifiable [n.q.]-0.14 μM, P < .001), healthy WHWTs (0.0052 μM, n.q.-1.2 μM, P = .003), LD (0.010 μM, n.q.-2.3 μM, P = .015), and CB (0.0078 μM, n.q.-0.073 μM, P = .018) groups compared to Beagles (0 μM, n.q.).Conclusion and clinical importanceThese results suggest that MA occurs in various respiratory diseases of dogs and also in healthy WHWTs.
| S-EPMC6271311 | biostudies-literature
Project description:Background and Objective: Presenting chronic obstructive pulmonary disease (COPD) patients frequently report concurrent symptoms of gastroesophageal reflux disease (GERD). Few studies have shown a correlation between GERD and COPD. We aimed to examine the correlation between GERD and COPD as well as secondary related reflux complications, such as esophageal stricture, esophageal cancer, and Barrett's esophagus. Methods: This population-based analysis included 7,159,694 patients. Patients diagnosed with GERD with and without COPD were compared to those without GERD. The enrollment of COPD included centrilobular and panlobular emphysema and chronic bronchitis. Risk factors of COPD or GERD were used for adjustment. Bivariate analyses were performed using the chi-squared test or Fisher exact test (2-tailed) for categorical variables as appropriate to assess the differences in the groups. Results: Our results showed that COPD patients had a significantly higher incidence of GERD compared to those without COPD (27.8% vs. 14.1%, p < 0.01). After adjustment of demographics and risk factors, COPD patients had a 1.407 times higher risk of developing non-erosive esophagitis (p < 0.01), 1.165 higher risk of erosive esophagitis (p < 0.01), 1.399 times higher risk of esophageal stricture (p < 0.01), 1.354 times higher risk of Barrett's esophagus without dysplasia (p < 0.01), 1.327 times higher risk of Barrett's esophagus with dysplasia, as well as 1.235 times higher risk of esophageal cancer than those without COPD. Conclusions: Based on the evidence from this study, there are sufficient data to provide convincing evidence of an association between COPD and GERD and its secondary reflux-related complications.
| S-EPMC10384576 | biostudies-literature
Project description:Reflux of gastric content has been associated with recurrent exacerbations of chronic obstructive pulmonary disease (COPD). We aimed to assess the prevalence of laryngopharyngeal reflux (LPR) in COPD and if LPR is a contributing factor to clinically relevant outcomes in COPD. We evaluated a total of 193 COPD patients (GOLD I-IV) with a 24-h laryngo-pharyngeal pΗ-monitor. LPR was observed in 65.8% of COPD patients and it was not significantly associated with clinically relevant outcomes of COPD. Treatment with PPI significantly decreased the upright RYAN score (p = 0.047) without improving lung function. Furthermore, the presence or severity of LPR cannot be diagnosed based solely on symptoms and questionnaires.
| S-EPMC7441701 | biostudies-literature
Project description:BackgroundThere is a need to find a simple, non-invasive and effective diagnostic tool for diagnosing gastroesophageal reflux-induced chronic cough (GERC) in clinic. This study aimed to evaluate the predictive diagnostic value of Hull airway reflux questionnaire (HARQ) and its combination with gastroesophageal reflux disease questionnaire (GerdQ) for GERC.MethodsChronic cough patients were enrolled and the diagnosis of GERC was established according to the chronic cough diagnosis and treatment process. The diagnostic value of HARQ and GerdQ alone or the combination of HARQ and GerdQ was analyzed.ResultsA total of 402 patients with chronic cough were eventually enrolled, including 166 GERC patients. When the HARQ score was used to predict the diagnosis of GERC, the area under the ROC curve was 0.796. The sensitivity and specificity were 77.19% and 77.06%, respectively. When the GerdQ was used to predict the diagnosis of GERC, the area under the ROC curve was 0.763. The sensitivity and specificity were 70.18% and 76.15%, respectively. When HARQ combined with GerdQ were used to predict the diagnosis of GERC, the area under the ROC curve was 0.848. The sensitivity and specificity were 77.19% and 79.82%, respectively.ConclusionsHARQ used to evaluate the cough hypersensitivity has a certain predictive diagnostic value for GERC. The diagnosis of GERC should be considered when the HARQ score is ≥24. The predictive diagnostic value of the combination of HARQ and GerdQ is significantly higher, which makes the diagnosis of GERC simpler, quicker and more effective.
| S-EPMC7791241 | biostudies-literature
Project description:ObjectivesInfants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS).MethodsWe performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results.ResultsOne hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043-1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04).ConclusionsI-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
| S-EPMC9765758 | biostudies-literature
Project description:BackgroundTo determine the relationship between gastroesophageal reflux disease (GORD) and its treatment and interstitial lung disease in patients with systemic sclerosis (SSc).MethodsSSc patients from the Australian Scleroderma Cohort Study (ASCS) were included. GORD was defined as self-reported GORD symptoms, therapy with a proton pump inhibitor (PPI) or histamine 2 receptor antagonist (H2RA) and/or the presence of reflux oesophagitis diagnosed endoscopically. The impact of GORD and its treatment on ILD features (including severity and time to ILD development) and survival was evaluated.ResultsGORD was a common manifestation affecting 1539/1632 (94%) of SSc patients. GORD affected 450/469 (96%) of those with SSc-ILD cohort. In SSc-ILD, there was no relationship between the presence of GORD or its treatment and time to ILD development or ILD severity. However, GORD treatment was associated with improved survival in those with ILD (p = 0.002). Combination therapy with both a PPI and a H2RA was associated with a greater survival benefit than single agent therapy with PPI alone (HR 0.3 vs 0.5 p < 0.050 respectively).ConclusionGORD is a common SSc disease manifestation. While the presence or treatment of GORD does not influence the development or severity of ILD, aggressive GORD treatment, in particular with a combination of PPI and H2RA, is associated with improved survival in those with SSc-ILD.
| S-EPMC11197189 | biostudies-literature
Project description:IntroductionGastroesophageal reflux disease (GORD) and aspiration are risk factors in the development of bronchiolitis obliterans syndrome (BOS) in the lung transplant population. The aim of this study was to investigate if allograft function and survival improved after anti-reflux surgery (ARS) in lung transplant recipients.MethodsIn accordance with PRISMA guidelines, we conducted a systematic search of MEDLINE, Embase, and the Cochrane library databases from inception until 13/01/2024. Articles reporting outcomes of ARS following lung transplantation were included. A random effects model was used for meta-analysis.ResultsThe search identified 20 which were used for quantitative analysis. Overall, FEV1 and rate of change of FEV1 had improved following ARS by 0.141 L/s (95% CI; -02.82, -0.001) and -1.153 mL/d (95% CI; -12.117, -0.188), respectively. Survival hazard ratio post-ARS was 0.39 (95% CI; 0.19, 0.60). Nissen fundoplication was the most effective anti-reflux procedure with the greatest effect on reduction in the rate of change of FEV1, with an improvement of -2.353 mL/d (95% CI; -3.058, -1.649).ConclusionARS in lung transplant recipients improves allograft function and survival. Given the increased incidence of GORD in lung transplant recipients, there should be a low threshold for investigation of GORD and subsequent ARS.
| S-EPMC11666770 | biostudies-literature
Project description:BackgroundAlthough chronic obstructive pulmonary disease (COPD) is closely associated with gastroesophageal reflux disease (GERD), the clinical significance of laryngopharyngeal reflux (LPR) is not fully understood in COPD.MethodsProspective cohorts were established among 118 patients with COPD from March 2013 to July 2014. Thirty-two age-matched and sex-matched normal controls, who had routine health check-ups during the study period, were included. Laryngopharyngeal reflux finding scores (RFS) and reflux symptom index (RSI) for LPR were subjected to association analysis with severity and acute exacerbation of COPD during the 1-year follow-up.ResultsThe mean age of patients enrolled in the study was 69.2±8.8 years, with 93.2% being male. Positive RFS (>7) and RSI (>13) were observed in 51 (42.5%) and six patients (5.0%), respectively. RFS and RSI were significantly higher in patients with COPD than in normal, healthy patients (P<0.001). RFS was significantly correlated with residual volume/total lung capacity (%, P=0.048). Scores for diffuse laryngeal edema, erythema, and hyperemia were significantly higher in the high-risk group (Global Initiative for Chronic Obstructive Lung Disease classification C and D; P=0.025 and P=0.049, respectively), while RSI was significantly higher in the more symptomatic group (Global Initiative for Chronic Obstructive Lung Disease classification B and D; P=0.047). RSI and RFS were significant predictors for severe acute exacerbation of COPD (P=0.03 and P=0.047, respectively), while only RSI was associated with severity of dyspnea.ConclusionLaryngeal examination and evaluation of laryngeal reflux symptom could be a surrogate clinical indicator related to severe acute exacerbation of COPD. Further studies of LPR in COPD patients should be considered.
| S-EPMC4507795 | biostudies-literature
Project description:Esophageal adenocarcinoma (EA) is a rapidly fatal cancer with rising incidence in the developed world. Most EAs arise in a metaplastic epithelium, Barrett's esophagus (BE), which is associated with greatly increased risk of EA. One of the key risk factors for both BE and EA is chronic gastroesophageal reflux disease (GERD). This study used the linkage disequilibrium (LD) score regression and genomic profile risk scoring approaches to investigate the contribution of multiple common single-nucleotide polymorphisms (SNPs) to the risk of GERD, and the extent of genetic overlap between GERD and BE or EA. Using LD score regression, we estimated an overall phenotypic variance of 7% (95% CI 3-11%) for GERD explained by all the genotyped SNPs. A genetic correlation of 77% (s.e. = 24%, P = 0.0012) between GERD and BE and 88% between GERD and EA (s.e. = 25%, P = 0.0004) was estimated using the LD score regression approach. Results from the genomic profile risk scoring approach, as a robustness check, were broadly similar to those from the LD score regression. This study provides the first evidence for a polygenic basis for GERD and supports for a polygenic overlap between GERD and BE, and GERD and EA.
| S-EPMC4743691 | biostudies-literature