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Esophageal motor disease and reflux patterns in patients with advanced pulmonary disease undergoing lung transplant evaluation
Author(s) -
Seccombe J.,
Mirza F.,
Hachem R.,
Gyawali C. P.
Publication year - 2013
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12135
Subject(s) - medicine , reflux , gastroenterology , lung , interstitial lung disease , pulmonary function testing , esophageal ph monitoring , cohort , ambulatory , obstructive lung disease , disease , gerd , pulmonary disease
Abstract Background Advanced pulmonary disorders are linked to esophageal hypomotility and reflux disease. However, characterization of esophageal function using high resolution manometry ( HRM ) and ambulatory pH monitoring, segregation by pulmonary pathology, and comparison to traditional reflux disease are all limited in the literature. Methods Over a 4 year period, 73 patients (55.2 ± 1.3 years, 44F) were identified who underwent esophageal function testing as part of lung transplant evaluation for advanced pulmonary disease (interstitial lung disease, ILD = 47, obstructive lung disease, OLD = 24, other = 2). Proportions of patients with motor dysfunction (≥80% failed sequences = severe hypomotility) and/or abnormal reflux parameters (acid exposure time, AET ≥ 4%) were determined, and compared to a cohort of 1081 patients (48.4 ± 0.4 years, 613F) referred for esophageal function testing prior to antireflux surgery ( ARS ). Key Results The proportion of esophageal body hypomotility was significantly higher within advanced pulmonary disease categories (35.6%), particularly ILD (44.7%), compared to ARS patients (12.1%, P < 0.0001). Abnormal AET was noted in 56.5%, and was similar between ILD and OLD , but less frequent than in the ARS group ( P = 0.04). Post‐transplant chronic rejection trended towards association with pretransplant elevated AET in OLD ( P = 0.08) but not ILD . Mortality was not predicted by esophageal motor pattern or reflux evidence. Conclusions & Inferences Interstitial lung disease has a highly significant association with esophageal body hypomotility. Consequently, prevalence of abnormal esophageal acid exposure is high, but implications for post lung transplant chronic rejection remain unclear.