J Neurogastroenterol Motil.  2018 Jul;24(3):395-402. 10.5056/jnm18023.

Abnormal Bolus Reflux Is Associated With Poor Pulmonary Outcome in Patients With Idiopathic Pulmonary Fibrosis

• Borges LF
• Jagadeesan V
• Goldberg H
• Gavini S
• Lo WK
• Burakoff R
• Feldman N
• Chan WW

• KMID: 2417383
• DOI: http://doi.org/10.5056/jnm18023

Abstract

BACKGROUND/AIMS
Gastroesophageal reflux (GER) is postulated to play a role in idiopathic pulmonary fibrosis (IPF). However, the value of objective GER measures in predicting IPF disease progression is unclear. We aim to evaluate the association between objective GER measures on multichannel intraluminal impedance and pH (MII-pH) testing and development of poor pulmonary outcomes within 1 year in pre-lung transplant IPF patients.
METHODS
This was a retrospective cohort study of adults with IPF who underwent pre-lung transplant evaluation with MII-pH off proton pump inhibitors (PPI) at a tertiary care center from June 2008 to November 2015. Patients were followed for 1 year from time of MII-pH for poor pulmonary outcomes, defined by hospitalization for respiratory exacerbation or death. Univariate, multivariate and time-to-event analyses were performed to assess associations between baseline GER parameters on MII-pH and poor outcomes.
RESULTS
Eighty-four subjects (mean age 61.1 years, 64.3% male) were included. Subjects with increased bolus exposure time (BET) had a higher incidence of 1-year poor pulmonary outcome vs normal BET (45.7% vs 15.2%, P = 0.006). Increased BET remained an independent predictor of poor outcome after controlling for age, gender, body mass index, smoking, lung disease severity, and PPI use (OR, 4.18; P = 0.030). Increased BET was also predictive of decreased time to poor pulmonary outcome (hazard ratio [HR], 4.88; P = 0.007). Subgroup analyses showed that increased BET remained independently associated with time to pulmonary hospitalization (HR, 4.00; P = 0.020), with a trend for 1-year mortality (HR, 2.19; P = 0.380).
CONCLUSION
Increased BET on MII-pH is an independent predictor of poor pulmonary outcome over 1 year in IPF patients.

Keyword

Aspiration; Extra-esophageal reflux; Gastroesophageal reflux; Lung disease; Outcomes

MeSH Terms

Adult
Body Mass Index
Cohort Studies
Disease Progression
Electric Impedance
Gastroesophageal Reflux
Hospitalization
Humans
Hydrogen-Ion Concentration
Idiopathic Pulmonary Fibrosis*
Incidence
Lung Diseases
Mortality
Proton Pump Inhibitors
Retrospective Studies
Smoke
Smoking
Tertiary Care Centers
Proton Pump Inhibitors
Smoke