Salvioli B, Belmonte G, Stanghellini V, Baldi E, Fasano L, Pacilli A M G, De Giorgio R, Barbara G, Bini L, Cogliandro R, Fabbri M, Corinaldesi R
Department of Internal Medicine & Gastroenterology, S. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Dig Liver Dis. 2006 Dec;38(12):879-84. doi: 10.1016/j.dld.2006.05.012. Epub 2006 Jul 7.
Interstitial lung disease is a heterogeneous entity, which encompasses a large number of pulmonary disorders, including idiopathic pulmonary fibrosis. Gastro-oesophageal reflux appears to be more prevalent in idiopathic pulmonary fibrosis than in controls and in patients with secondary pulmonary fibrosis, but its contribution to interstitial lung disease remains unsettled.
To prospectively evaluate gastro-oesophageal reflux in patients with interstitial lung disease and to define acid reflux patterns in patients with idiopathic and secondary forms of pulmonary fibrosis.
Twenty-eight patients (15M, median age 66 years, interquartile range 60-71) were studied by history taking, pulmonary function tests, high resolution computed tomography, oesophageal manometry and 24h oesophago-gastric pH monitoring.
Sixteen patients (57%) had typical reflux symptoms. All patients completed 24h pH metry and 14 underwent oesophageal manometry. An abnormal oesophageal acid exposure was observed in 19 patients (68%), 13 of which complained of predominant typical reflux symptoms. A diagnosis of idiopathic pulmonary fibrosis was made in 18 patients, while the remaining 10 patients were classified as secondary pulmonary fibrosis. Secondary pulmonary fibrosis patients had more restrictive lung defect, as expressed as Tiffeneau index (p<0.05) and greater acid reflux at nighttime (p<0.05) than idiopathic pulmonary fibrosis patients.
The prevalence of abnormal acid reflux in interstitial lung disease patients is high and, in particular, patients with secondary pulmonary fibrosis show higher oesophageal acid exposure than those with idiopathic form.
间质性肺疾病是一种异质性疾病，涵盖大量肺部疾病，包括特发性肺纤维化。胃食管反流在特发性肺纤维化患者中似乎比对照组和继发性肺纤维化患者更为普遍，但其对间质性肺疾病的影响仍未明确。
前瞻性评估间质性肺疾病患者的胃食管反流情况，并确定特发性和继发性肺纤维化患者的酸反流模式。
通过病史采集、肺功能测试、高分辨率计算机断层扫描、食管测压和24小时食管-胃pH监测对28例患者（15例男性，中位年龄66岁，四分位间距60 - 71岁）进行研究。
16例患者（57%）有典型反流症状。所有患者均完成24小时pH测量，14例接受食管测压。19例患者（68%）观察到食管酸暴露异常，其中13例主诉主要为典型反流症状。18例患者诊断为特发性肺纤维化，其余10例患者归类为继发性肺纤维化。继发性肺纤维化患者的肺限制性缺陷更明显，以蒂芬诺指数表示（p<0.05），夜间酸反流比特发性肺纤维化患者更严重（p<0.05）。
间质性肺疾病患者中异常酸反流的患病率较高，特别是继发性肺纤维化患者的食管酸暴露高于特发性肺纤维化患者。
