Abstract:Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract in the Western world. GERD pathophysiology is multifactorial. Different mechanisms may contribute to GERD including an increase in the transdiaphragmatic pressure gradient (TPG). The pathophysiology of GERD linked to TPG is not entirely understood. This review shows that TPG is an important contributor to GERD even when an intact esophagogastric barrier is present in the setting of obesity and pulmonary diseas… Show more
“…8 In certain circumstances, GERD may occur in the setting of a normal valvular mechanism due to an altered transdiaphragmatic pressure gradient. 9 Abdominal pressure may be abnormally increased surpassing the retention pressure of the esophagogastric valve in obese patients. 10 On the other side, thoracic pressure may be decreased in patients with restrictive pulmonary diseases 11 : this may be the case in patients with IPF.Figure 1.Gastroesophageal reflux disease pathophysiology.…”
Idiopathic pulmonary fibrosis (IPF) and gastroesophageal reflux disease (GERD) are undoubtedly related. Even though it is not clear yet which one is the primary disease, they certainly interact increasing each other’s severity. Symptoms are unreliable to diagnose GERD in patients with IPF, and objective evaluation with pH monitoring and/or bronchoalveolar lavage analysis is mandatory. Pharmacological treatment with proton pump inhibitors (PPIs) may bring control of IPF in few patients, but PPIs do not control reflux but just change the pH of the gastric refluxate. Surgical therapy based on a fundoplication is safe and effective as it controls any type of reflux, independently from the pH of the gastric refluxate. In patients waiting for lung transplantation (if they can tolerate a laparoscopic operation under general anesthesia), a fundoplication before the operation might block the progression of IPF, while after transplantation it might prevent rejection by preventing the bronchiolitis obliterans syndrome.
“…8 In certain circumstances, GERD may occur in the setting of a normal valvular mechanism due to an altered transdiaphragmatic pressure gradient. 9 Abdominal pressure may be abnormally increased surpassing the retention pressure of the esophagogastric valve in obese patients. 10 On the other side, thoracic pressure may be decreased in patients with restrictive pulmonary diseases 11 : this may be the case in patients with IPF.Figure 1.Gastroesophageal reflux disease pathophysiology.…”
Idiopathic pulmonary fibrosis (IPF) and gastroesophageal reflux disease (GERD) are undoubtedly related. Even though it is not clear yet which one is the primary disease, they certainly interact increasing each other’s severity. Symptoms are unreliable to diagnose GERD in patients with IPF, and objective evaluation with pH monitoring and/or bronchoalveolar lavage analysis is mandatory. Pharmacological treatment with proton pump inhibitors (PPIs) may bring control of IPF in few patients, but PPIs do not control reflux but just change the pH of the gastric refluxate. Surgical therapy based on a fundoplication is safe and effective as it controls any type of reflux, independently from the pH of the gastric refluxate. In patients waiting for lung transplantation (if they can tolerate a laparoscopic operation under general anesthesia), a fundoplication before the operation might block the progression of IPF, while after transplantation it might prevent rejection by preventing the bronchiolitis obliterans syndrome.
“…In the journal Arquivos de Gastroenterologia, two articles were published simultaneously, emanating from one institution and devoted to high resolution manometry (HRM) of the esophagus and the lower esophageal sphincter (1,2) . The first study aims to determinate the normative data for a new 24 channel water-perfused HRM (1) .…”
mentioning
confidence: 99%
“…III. The purpose of the second article was to study the role of transdiaphragmatic pressure gradient (TPG) on GERD pathophysiology (2) . The authors measured in "healthy" subjects gastric / abdominal pressure (AP) and esophageal / thoracic pressure (TP) using…”
“…The management of gastroesophageal reflux disease and other esophageal motility disorders is highly dependent on these tests. We thank Dr. Levin for his interest in two of our studies (1,2) . We were thrilled with his disapproval of current methods to evaluate esophageal physiology.…”
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