Posner S, Zheng J, Wood R K, Shimpi R A, Hartwig M G, Chow S-C, Leiman D A
Department of Medicine, Duke University Medical Center.
Department of Biostatistics and Bioinformatics, Duke University Medical Center.
Dis Esophagus. 2018 May 1;31(5). doi: 10.1093/dote/dox157.
Gastroesophageal reflux disease and esophageal dysmotility are prevalent in patients with advanced lung disease and are associated with graft dysfunction following lung transplantation. As a result, many transplant centers perform esophageal function testing as part of the wait-listing process but guidelines for testing in this population are lacking. The aim of this study is to describe whether symptoms of gastroesophageal reflux correlate with abnormal results on pH-metry and high-resolution manometry and can be used to identify those who require testing. We performed a retrospective cohort study of 226 lung transplant candidates referred for high-resolution manometry and pH-metry over a 12-month period in 2015. Demographic data, results of a standard symptom questionnaire and details of esophageal function testing were obtained. Associations between the presence of symptoms and test results were analyzed using Fisher's exact tests and multivariable logistic regression. The most common lung disease diagnosis was interstitial lung disease (N = 131, 58%). Abnormal pH-metry was seen in 116 (51%) patients and the presence of symptoms was significantly associated with an abnormal study (p < 0.01). Dysmotility was found in 98 (43%) patients, with major peristaltic or esophageal outflow disorders in 45 (20%) patients. Symptoms were not correlated with findings on esophageal high-resolution manometry. Fifteen of 25 (60%) asymptomatic patients had an abnormal manometry or pH-metry. These results demonstrate that in patients with advanced lung disease, symptoms of gastroesophageal reflux increase the likelihood of elevated acid exposure on pH-metry but were not associated with dysmotility. Given the proportion of asymptomatic patients with abnormal studies and associated post-transplant risks, a practice of universal high-resolution manometry and pH-metry testing in this population is justifiable.
胃食管反流病和食管动力障碍在晚期肺病患者中很常见，并且与肺移植后的移植物功能障碍相关。因此，许多移植中心在等待名单流程中进行食管功能测试，但缺乏针对该人群的测试指南。本研究的目的是描述胃食管反流症状是否与pH值测定和高分辨率测压的异常结果相关，以及是否可用于识别那些需要进行测试的患者。我们对2015年12个月期间转诊进行高分辨率测压和pH值测定的226例肺移植候选者进行了一项回顾性队列研究。获取了人口统计学数据、标准症状问卷的结果以及食管功能测试的详细信息。使用Fisher精确检验和多变量逻辑回归分析症状的存在与测试结果之间的关联。最常见的肺病诊断是间质性肺病（N = 131，58%）。116例（51%）患者pH值测定异常，症状的存在与异常检查显著相关（p < 0.01）。98例（43%）患者存在动力障碍，45例（20%）患者存在主要蠕动或食管流出道障碍。症状与食管高分辨率测压结果无关。25例无症状患者中有15例（60%）测压或pH值测定异常。这些结果表明，在晚期肺病患者中，胃食管反流症状增加了pH值测定时酸暴露升高的可能性，但与动力障碍无关。鉴于无症状患者检查异常的比例以及相关的移植后风险，对该人群进行普遍的高分辨率测压和pH值测定是合理的。
