Prevalence and effects of gastro-oesophageal reflux during spirometry in subjects undergoing reflux assessment

Abstract

Variability during spirometry can persist despite control of technical and personal factors. We postulate spirometry induces gastro-oesophageal reflux (GOR), which may cause variability and affect results of spirometry. Fifty-eight (58) subjects undergoing GOR investigation with oesophageal manometry and 24hr pH monitoring were recruited. Oesophageal dysmotility and GOR were assessed as part of clinical care. Subjects performed 2 sets of spirometry separated by a 10-minute rest period. The assessment of GOR during spirometry procedure (defined by a lower oesophageal pH<4) started from the first set of spirometry and concluded when the second set of spirometry was completed. We calculated variability (%) of FEV 1 , FVC and PEFR within each set as well as changes over 10-minutes. Twenty-six subjects (45%) recorded GOR during assessment. Of these, 23 subjects recorded GOR during the 10-minute rest period. Four subjects had GOR recorded only during spirometry tests. We did not find variability of spirometry parameters between the groups with and without GOR during spirometry procedure. However, in subjects with GOR, we found small but significant reductions of PEFR (0.5L/s, 8%, p<0.001) and FEV 1 (84 mL, 3%, p = 0.048) in the second set of spirometry compared to the first spirometry set. This pilot study demonstrates that GOR can occur during and following spirometry. Presence of GOR during spirometry in this patient population caused small decreases in PEFR and FEV 1 when it is repeated 10-minutes later however not increase variability in a single series of measurements.

Mechanism of spirometry associated gastro-esophageal reflux in individuals undergoing esophageal assessment

“…These findings were validated using impedance fluid flow analysis. Notably, spirometry induced GER events were more pronounced in our current investigation than in our earlier study [2]. This discrepancy likely arises from enhanced sensitivity of impedance sensors, which can detect various…”

“…These findings were validated using impedance fluid flow analysis. Notably, spirometry induced GER events were more pronounced in our current investigation than in our earlier study [ 2 ]. This discrepancy likely arises from enhanced sensitivity of impedance sensors, which can detect various types of reflux (acidic, weakly acidic, and non-acidic reflux), in contrast to the ambulatory pH probe exclusively capturing acidic reflux in our previous research.…”

“…Despite its safety and reproducibility [ 1 ], variability in spirometry results can persist in some patients despite control for technical factors and patient technique. Recent evidence suggests that spirometry maneuvers, can induce gastroesophageal reflux (GER) [ 2 ]. This phenomenon has implications for spirometry interpretation and patient management.…”

Unraveling the Dynamics of Esophageal Motility, Esophagitis Severity, and Age in GERD Patients: A Cross-Sectional Exploration

“…While our study primarily focused on esophageal motility and its association with the severity of esophagitis, it is crucial to acknowledge that other factors, such as dietary habits, lifestyle choices, and concurrent medications, can also influence esophageal function [ 12 , 13 ]. Future research should adopt a more comprehensive approach, encompassing a broader range of potential contributing factors.…”

“…Nevertheless, the higher intensity of esophagitis was associated with a modest decrease in distal amplitude, suggesting its potential importance in determining the severity of esophagitis. However, conflicting results question the association between ineffective esophageal motility and the presence of esophagitis [11][12][13].…”