Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
J Surg Res. 2014 Jun 15;189(2):232-7. doi: 10.1016/j.jss.2014.03.025. Epub 2014 Mar 15.
Patients with scleroderma and end-stage lung disease (ESLD) have a very high prevalence of gastroesophageal reflux disease (GERD). Because GERD has been associated with aspiration in those with ESLD, and because those with scleroderma are particularly prone to develop severe GERD, there is some concern that GERD may contribute to shorten survival in patients with scleroderma awaiting lung transplantation. Therefore, we hypothesized that esophageal pH monitoring could predict survival of those with scleroderma and ESLD awaiting lung transplantation and that the severity of reflux can impact survival.
We conducted a retrospective analysis of all scleroderma patients referred for lung transplantation who underwent esophageal manometry and pH monitoring since August 2008. We identified 10 patients in whom we calculated and compared the area under the curve for each receiver operating characteristic curve of the following variables: DeMeester score, forced expiratory volume in 1 s (FEV1), %predicted FEV1, forced vital capacity (FVC), %predicted FVC, diffusion capacity for carbon monoxide (DLco), and %predicted DLco.
The DeMeester score nominally outperformed FEV1, FVC, and DLco. Receiver operating characteristic curve analysis was also used to define the optimal DeMeester score (65.2) in differentiating survival status, as determined by maximizing sensitivity and specificity. Based on this value, we calculated the 1-y survival from the time of the esophageal function testing, which was 100% in seven patients with a DeMeester score of <65.2, and 33% in three patients with a score >65.2 (P = 0.01). The latter patients had greater total time pH < 4, greater time pH < 4 in the supine position, greater total episodes of reflux, and higher prevalence of absent peristalsis. The single survivor with a DeMeester score >70 had also proximal reflux, underwent antireflux surgery, and is alive 1201 d after transplant.
Our study shows that esophageal pH monitoring can predict survival status in patients with scleroderma awaiting lung transplantation and that the severity of reflux can impact the 1-y survival rate. Therefore, esophageal pH monitoring should be considered early in patients with scleroderma and ESLD, as this test could appropriately identify those in whom laparoscopic antireflux surgery should be performed quicker to prevent GERD and its detrimental effects in patients awaiting lung transplantation.
硬皮病合并终末期肺病（ESLD）患者胃食管反流病（GERD）的患病率非常高。由于 GERD 与 ESLD 患者的吸入有关，而且硬皮病患者特别容易发生严重的 GERD，因此有人担心 GERD 可能会缩短肺移植等待患者的生存时间。因此，我们假设食管 pH 监测可以预测肺移植等待患者的生存率，并且反流的严重程度会影响生存率。
我们对自 2008 年 8 月以来接受过食管测压和 pH 监测的所有硬皮病患者进行了回顾性分析。我们确定了 10 名患者，我们计算并比较了以下变量的每个接收器操作特征曲线的曲线下面积：DeMeester 评分、用力呼气量 1 秒（FEV1）、预测 FEV1%、用力肺活量（FVC）、预测 FVC%、一氧化碳弥散量（DLco）和预测 DLco%。
DeMeester 评分在预测 FEV1、FVC 和 DLco 方面具有优势。还使用接收器操作特征曲线分析来定义最佳 DeMeester 评分（65.2），以通过最大化灵敏度和特异性来区分生存状态。根据该值，我们计算了从食管功能测试时间开始的 1 年生存率，在 DeMeester 评分<65.2 的 7 名患者中为 100%，在评分>65.2 的 3 名患者中为 33%（P=0.01）。评分>65.2 的后 3 名患者的总 pH 值<4 时间更长，仰卧位时 pH 值<4 时间更长，反流总发作次数更多，无蠕动的发生率更高。评分>70 的唯一存活患者也有近端反流，接受了抗反流手术，并在移植后 1201 天存活。
我们的研究表明，食管 pH 监测可以预测肺移植等待患者的生存状态，反流的严重程度会影响 1 年生存率。因此，应在硬皮病合并 ESLD 患者中尽早进行食管 pH 监测，因为该测试可以适当识别出应尽快进行腹腔镜抗反流手术的患者，以防止 GERD 及其对肺移植等待患者的不利影响。
