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doi:10.1378/chest.06-1906
(Chest. 2007; 131:1166-1172)
© 2007 American College of Chest Physicians
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Gastroesophageal Reflux Disease, Acid Suppression, and Mycobacterium avium Complex Pulmonary Disease*

Rachel M. Thomson, MBBS; John G. Armstrong, MBBS, PhD and David F. Looke, MBBS

* From the Department of Thoracic Medicine (Dr. Thomson), The Prince Charles Hospital, Chermside; and the Departments of Respiratory Medicine (Dr. Armstrong) and Infectious Diseases (Dr. Looke), Princess Alexandra Hospital, South Brisbane, QLD, Australia.

Correspondence to: Rachel Thomson, MBBS, Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, QLD, Australia 4064; e-mail: R.Thomson{at}mailbox.uq.edu.au

Abstract

Background: Weekly symptoms of gastroesophageal reflux disease (GERD) occur in 20% of the population, and GERD has been implicated in the pathophysiology of many respiratory diseases. Microaspiration of contaminated water is a potential portal of entry for Mycobacterium avium complex (MAC) organisms into the respiratory tract, and acid-suppression therapy may enhance the survival of mycobacteria in the stomach. This study aimed to assess the prevalence of GERD, swallowing disorders, reflux symptoms, and acid-suppression therapy in patients with MAC lung disease (MAC positive [MAC+]), and to compare these patients to control subjects without MAC lung disease (MAC negative [MAC–]).

Methods: Clinical information was collected on 58 MAC+ patients and 58 age- and sex-matched MAC– patients who were asked to complete a DeMeester questionnaire of reflux symptoms and to identify any acid-suppressive medication consumed.

Results: A clinical diagnosis of GERD was documented in 23 of 52 MAC+ patients (44.2%), compared to 16 MAC– patients (27.6%) [p = 0.019]. MAC+ patients consumed significantly more histamine type 2 receptor antagonists and prokinetic agents, and MAC– patients consumed more antacids. The mean DeMeester questionnaire score (± SD) for MAC+ patients was 1.39 ± 1.8, and for MAC– patients was 0.88 ± 1.4. (p = 0.098). Aspiration was suspected in nine MAC+ patients (15.5%), compared to three MAC– patients (5.2%) [p = 0.032]. There was no association between GERD and radiologic presentation of MAC disease. Consolidation and nodules > 5 mm were more common in those receiving acid suppression than those who were not.

Conclusions: GERD, acid suppression, and clinically suspected aspiration are more common in patients with MAC lung disease than in similar patients without MAC disease.

Key Words: bronchiectasis • esophagus • gastroesophageal reflux • infection • mycobacterial






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