Proximal and distal gastro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis
Corresponding Author
Annemarie L. Lee
Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
Correspondence: Annemarie L. Lee, Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Vic. 3010, Australia. Email: [email protected]Search for more papers by this authorBrenda M. Button
Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorLinda Denehy
Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Search for more papers by this authorStuart J. Roberts
Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorTiffany L. Bamford
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Janssen, Pharmaceutical Companies of Johnson and Johnson, Melbourne, Victoria, Australia
Search for more papers by this authorSamantha J. Ellis
Department of Radiology, The Alfred, Melbourne, Victoria, Australia
Search for more papers by this authorFi-Tjen Mu
Department of Immunology, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorRalf G. Heine
Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorRobert G. Stirling
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorJohn W. Wilson
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
Annemarie L. Lee
Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
Correspondence: Annemarie L. Lee, Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Vic. 3010, Australia. Email: [email protected]Search for more papers by this authorBrenda M. Button
Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorLinda Denehy
Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Search for more papers by this authorStuart J. Roberts
Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorTiffany L. Bamford
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Janssen, Pharmaceutical Companies of Johnson and Johnson, Melbourne, Victoria, Australia
Search for more papers by this authorSamantha J. Ellis
Department of Radiology, The Alfred, Melbourne, Victoria, Australia
Search for more papers by this authorFi-Tjen Mu
Department of Immunology, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorRalf G. Heine
Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorRobert G. Stirling
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorJohn W. Wilson
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorAbstract
Background and objective
The aims of this observational study were (i) to examine the prevalence of symptomatic and clinically silent proximal and distal gastro-oesophageal reflux (GOR) in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis, (ii) the presence of gastric aspiration, and (iii) to explore the possible clinical significance of this comorbidity in these conditions.
Methods
Twenty-seven participants with COPD, 27 with bronchiectasis and 17 control subjects completed reflux symptom evaluation and dual-channel 24 h oesophageal pH monitoring. In those with lung disease, pepsin levels in sputum samples were measured using enzyme-linked immunosorbent assay, with disease severity (lung function and high-resolution computed tomography) also measured.
Results
The prevalence of GOR in COPD was 37%, in bronchiectasis was 40% and in control subjects was 18% (P = 0.005). Of those diagnosed with GOR, clinically silent reflux was detected in 20% of participants with COPD and 42% with bronchiectasis. While pepsin was found in 33% of COPD and 26% of bronchiectasis participants, the presence of pepsin in sputum was not related to a diagnosis of GOR based on oesophageal pH monitoring in either condition. Neither a diagnosis of GOR nor the presence of pepsin was associated with increased severity of lung disease in COPD or bronchiectasis.
Conclusions
The prevalence of GOR in COPD or bronchiectasis is twice that of the control population, and the diagnosis could not be based on symptoms alone. Pepsin was detected in sputum in COPD and bronchiectasis, suggesting a possible role of pulmonary aspiration, which requires further exploration.
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