Chest
Volume 123, Issue 6, June 2003, Pages 1932-1938
Journal home page for Chest

Clinical Investigations
Pulmonary Function Tests
Severe Gastroesophageal Reflux Is Associated With Reduced Carbon Monoxide Diffusing Capacitya

https://doi.org/10.1378/chest.123.6.1932Get rights and content

Objective

To assess whether severe gastroesophageal reflux (GER) is associated with abnormalities in lung function including measures of lung volume and gas diffusion.

Methods

Data from 147 patients with obesity (body mass index [BMI] range, 31.7 to 70 kg/m2) who presented for obesity surgery was analyzed retrospectively. A questionnaire was completed preoperatively that included a history of GER, frequency and severity of symptoms, investigations, and medications used. A history of lung disease, sleep-disordered breathing, and smoking also was obtained. A physician who was blinded to lung function graded GER severity prospectively by the results of pH monitoring and/or gastroscopy, and medication use. Spirometry, lung volumes, and gas transfer were measured preoperatively.

Results

Patients with severe GER had reduced levels of the diffusing capacity of the lung for carbon monoxide (Dlco) [21.1 mL/min/mm Hg; 95% confidence interval (CI), 18.9 to 23.2], as measured by CO transfer, compared with those patients without GER (26.3 mL/min/mm Hg; 95% CI, 24.4 to 28.2; p = 0.001). This remained significant after adjusting for age, gender, BMI, and smoking history. Gas transfer corrected for lung volume also was reduced in the group with severe GER (4.6 mL/min/mm Hg per L; 95% CI, 4.3 to 4.9) compared to the group without GER (5.3 mL/min/mm Hg per L; 95% CI, 5.1 to 5.5; p = 0.001). There was no significant difference in other measures of lung function.

Conclusions

Severe GER is associated with an impairment of gas exchange. This may be due to microaspiration of gastric acid or fluid into the airways.

Section snippets

Samples and Selection Criteria

Data on 147 consecutive patients who presented for weight loss surgery were assessed retrospectively. Patients are considered for obesity surgery if they present with a body mass index (BMI) of > 35 kg/m2 and are experiencing significant medical, physical, or psychosocial disabilities.

Preoperatively, a full medical history was taken and a physical examination was performed. Information on GER included history, previous investigations, and medication usage. Patients completed a questionnaire

Results

Data from 147 consecutive obese patients (BMI range, 31.7 to 70 kg/m2) were analyzed retrospectively. Patient demographics are in Table 1. The patients with grade 3 GER were significantly older (p = 0.006).

The group with grade 3 GER (n = 21) did not have an increased prevalence of current smoking (Table 1), although there was a difference between groups in the number of pack-years previously smoked (p < 0.001). This increase in pack-years smoked was present in the grade 2 (mild GER) group only

Discussion

The principle finding of this study was that severe GER, defined by the findings of pH monitoring and/or gastroscopy, is associated with a reduction in gas diffusion. This effect was not due to differences in obesity, weight distribution, spirometric function, or lung volumes. Furthermore, there did not appear to be any other relevant medical history to account for these gas exchange abnormalities.

The current series is the largest to date assessing GER and diffusing capacity. No previous

References (35)

  • BM Button et al.

    Postural drainage in cystic fibrosis: is there a link with gastro-oesophageal reflux?

    J Paediatr Child Health

    (1998)
  • DA Johnson et al.

    Pulmonary disease in progressive systemic sclerosis: a complication of gastroesophageal reflux and occult aspiration?

    Arch Intern Med

    (1989)
  • AJ Ing et al.

    Obstructive sleep apnea and gastroesophageal reflux

    Am J Med

    (2000)
  • JL Colombo et al.

    Airway reactivity following repeated milk aspiration in rabbits

    Pediatr Pulmonol

    (2000)
  • B Avidan et al.

    Temporal associations between coughing or wheezing and acid reflux in asthmatics

    Gut

    (2001)
  • SM Harding

    Gastroesophageal reflux, asthma, and mechanisms of interaction

    Am J Med

    (2001)
  • AJ Ing

    Interstitial lung disease and gastroesophageal reflux

    Am J Med

    (2001)
  • Cited by (28)

    • Pathobiology of Novel Approaches to Treatment

      2018, Interstitial Lung Disease
    • Respiratory function after esophageal replacement in children

      2017, Journal of Pediatric Surgery
      Citation Excerpt :

      The restrictive ventilatory disorder may also be related to active damage of lung tissues promoted by the transposed stomach. Reflux and prolonged (micro) aspiration in the airways may cause chronic pulmonary inflammation, potentially progressing to fibrosis [36]. However, diffusion abnormalities were not measured in both groups.

    • Idiopathic pulmonary fibrosis: current and future directions

      2017, Clinical Radiology
      Citation Excerpt :

      A recent systematic literature review found wide variability in these common co-morbidities: pulmonary hypertension (PH) 3–86%, lung cancer 3–48%, gastro-oesophageal reflux disease (GORD) 0–94%.55 GORD is cited as both a risk factor and complication and anti-acid treatment in IPF patients is reportedly beneficial.57,58 A proposed pathophysiological mechanism is repeated micro-aspiration of gastric contents causing persistent pulmonary epithelial injury, triggering a fibrotic reparative process.56

    • Pulmonary Manifestations of Systemic Disorders

      2008, Pediatric Respiratory Medicine
    View all citing articles on Scopus

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    View full text