Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

Fortunato, Gustavo; Machado, Mirna Mota; Andrade, Cristiano Feijó; Felicetti, José Carlos; Camargo, José de Jesus Peixoto; Cardoso, Paulo Francisco Guerreiro

doi:10.1590/s1806-37132008001000004

Cited by 22 publications

(10 citation statements)

References 15 publications

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“…Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence from 26% to 75%, and aspiration of gastric contents in the respiratory tree is not rare in patients with GER [19,20]. In a group of patients with advanced lung disease including bronchiectasis manometry showed that 57% of patients had LES hypotonia and 14% had UES hypotonia [21]. Similar results were found in the seven patients of our study.…”

Section: Discussionsupporting

confidence: 85%

Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

Wang

Zhang

et al. 2013

BMC Pulm Med

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BackgroundBronchiectasis is a progressive and fatal disease despite the available treatment regimens. Gastroesophageal reflux (GER) may play an important role in the progression of bronchiectasis. However, active anti-reflux intervention such as Stretta radiofrequency (SRF) and/or laparoscopic fundoplication (LF) have rarely been used to treat Bronchiectasis.Case PresentationSeven patients’ clinical outcomes for treating GER-related deteriorated bronchiectasis were retrospective reviewed. All patients were treated by SRF and/or LF, and had follow-up periods ranging from one to five years. Typical GER symptoms, respiratory symptoms, medication consumption and general health status were assessed during the follow-ups. At the latest follow-up all patients were alive. The typical GER symptoms disappeared in five people and were significantly improved in the other two. Two had complete remissions of both respiratory symptoms and bronchiectasis exacerbations; four had significantly improved respiratory symptoms to mild/moderate degrees as well as reduced or zero bronchiectasis exacerbations, which allowed them to resume the physical and social functions; one’s respiratory symptoms and bronchiectasis exacerbations were not much improved, yet she was in stable condition and satisfied with the results.ConclusionsPotentially, GER plays an important role in some patients with bronchiectasis, and active anti-reflux treatments can be beneficial. Future clinical studies are suggested to clarify GER’s role in bronchiectasis and to further determine whether anti-reflux interventions for GER can improve the outcomes of patients with bronchiectasis.

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Section: Discussionsupporting

confidence: 85%

Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

Wang

Zhang

et al. 2013

BMC Pulm Med

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“…A number of possible mechanisms originating from a gastrointestinal or respiratory perspective may increase the vulnerability to GERD in those with COPD. Although esophageal motility studies have not been extensively applied, reduced daytime and nocturnal esophageal peristalsis 40 , 56 , 81 and a decrease in UES 82 , 83 and LES pressure has been demonstrated in those with severe COPD. 11 , 40 , 64 , 82 Change in LES pressure may be partially attributed to smoking and the effects of nicotine.…”

Section: Possible Contributing Factors To Gerd In Copdmentioning

confidence: 99%

Gastroesophageal reflux disease in COPD: links and risks

Lee

Goldstein

2015

COPD

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COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms) and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD) and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the treatment of GERD in COPD and while extensive studies in this population have not been undertaken, this comorbidity may be amenable to treatment.

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“…However, the relationship of reflux to clinical presentation or its association with lung disease severity was not evaluated [54]. Similar results were found in a study of seven patients with advanced bronchiectasis awaiting lung transplantation, with 33% experiencing an increased number of distal reflux episodes, specifically in the supine position [55]. In addition, manometry studies showed LOS hypotonia in 57% of those patients with upper oesophageal sphincter hypotonia in 14% of patients.…”

Section: Gor In Bronchiectasismentioning

confidence: 87%

“…In addition, manometry studies showed LOS hypotonia in 57% of those patients with upper oesophageal sphincter hypotonia in 14% of patients. This suggests that the gastrointestinal contributions to GOR which have been identified in patients with chronic obstructive pulmonary disease, cystic fibrosis, and interstitial lung disease [54, 55] may also be apparent in bronchiectasis. …”

Section: Gor In Bronchiectasismentioning

confidence: 99%

Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis

et al. 2011

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The clinical presentation of noncystic fibrosis bronchiectasis may be complicated by concomitant conditions, including gastro-oesophageal reflux (GOR). Increased acidic GOR is principally caused by gastro-oesophageal junction incompetence and may arise from lower oesophageal sphincter hypotension, including transient relaxations, hiatus hernia, and oesophageal dysmotility. Specific pathophysiological features which are characteristic of respiratory diseases including coughing may further increase the risk of GOR in bronchiectasis. Reflux may impact on lung disease severity by two mechanisms, reflex bronchoconstriction and pulmonary microaspiration. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence of 26 to 75%. The cause and effect relationship has not been established, but preliminary reports suggest that GOR may influence the severity of bronchiectasis. Further studies examining the implications of GOR in this condition, including its effect across the disease spectrum using a combination of diagnostic tools, will clarify the clinical significance of this comorbidity.

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Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

Cited by 22 publications

References 15 publications

Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

Gastroesophageal reflux disease in COPD: links and risks

Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis

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