Chest
Volume 131, Issue 6, June 2007, Pages 1666-1671
Journal home page for Chest

ORIGINAL RESEARCH
COPD
High Prevalence of Proximal and Distal Gastroesophageal Reflux Disease in Advanced COPD

https://doi.org/10.1378/chest.06-2264Get rights and content

Background

Gastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of COPD. The aims of this study were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD.

Methods

Forty-one COPD patients with a mean FEV1 of 24% of predicted underwent dual-probe 24-h esophageal pH monitoring, and 1 patient underwent esophagogastroduodenoscopy.

Results

The prevalence of GERD was 57%. Elevated distal and proximal reflux were present in 41% and 46% of patients undergoing esophageal pH studies, respectively. Fifteen percent of these patients had abnormal proximal reflux despite having normal distal probe results. Most patients with GERD were not receiving acid blockers at the time of their referral, and only one third reported heartburn and/or acid regurgitation during the pH study. Only higher body mass index was predictive of reflux on regression analysis (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.5; p = 0.05).

Conclusions

GERD is common in advanced COPD. Patients are often asymptomatic and have a relatively high prevalence of isolated abnormal proximal reflux. Dual-probe monitoring is therefore well suited for detecting GERD in patients with advanced COPD.

Section snippets

Materials and Methods

This study was approved by the University of Minnesota Institutional Review Board.

Results

A total of 51 COPD patients underwent screening for lung transplantation during the study period; of these, 42 patients (82%) underwent testing for gastroesophageal reflux. GERD assessment included manometry and 24-h esophageal pH monitoring in 41 patients and EGD in 1 patient. Four patients did not undergo testing due to early identification of a contraindication to transplantation, and one patient did not tolerate placement of the pH probe; the reason for no evaluation in the remaining four

Discussion

This series of patients with advanced COPD found a prevalence of GERD approximately five times that of the general population.19 A strikingly high proportion of patients had proximal reflux disease, often in the absence of pathologic amounts of distal reflux. The lack of association between reflux symptoms and the diagnosis of GERD, along with the small proportion of patients with GERD receiving acid blockers at the time of their referral, suggests there is a large burden of clinically silent

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    There was no external funding associated with this work.

    No financial or other potential conflicts of interest exist for any of the authors.

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