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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2264v1 131/6/1666    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kempainen, R. R. Articles by Billings, J. L. Search for Related Content PubMed PubMed Citation Articles by Kempainen, R. R. Articles by Billings, J. L.

High Prevalence of Proximal and Distal Gastroesophageal Reflux Disease in Advanced COPD

Robert R. Kempainen, MD^*; Kay Savik, MS; Timothy P. Whelan, MD^*; Jordan M. Dunitz, MD^*; Cynthia S. Herrington, MD and Joanne L. Billings, MD, MPH^*

^* Division of Pulmonary, Allergy and Critical Care, Department of Internal Medicine School of Nursing Department of Surgery, University of Minnesota School of Medicine, Minneapolis, MN, U.S.A

kempa001{at}umn.edu

Abstract

BackgroundGastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). The study's aims were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD.

MethodsForty-one COPD patients with a mean FEV1 of 24% predicted underwent dual probe 24-hour esophageal pH monitoring and 1 patient underwent esophagogastroduodenoscopy.

ResultsThe prevalence of GERD was 57%. Elevated distal and proximal reflux was present in 41% and 46% of patients undergoing esophageal pH studies, respectively. Fifteen percent of these patients had abnormal proximal reflux despite having normal distal probe results. Most patients with GERD were not on acid blockers at the time of their referral, and only one-third reported heartburn and/or acid regurgitation during their pH study. Only higher BMI was predictive of reflux on regression analysis (OR 1.2, 95% CI 1.0, 1.5, p = .05).

ConclusionsGERD is common in advanced COPD. Patients are often asymptomatic and have a relatively high prevalence of isolated abnormal proximal reflux. Dual probe monitoring is therefore well-suited for detecting GERD in patients with advanced COPD.

Key Words: acid-blockers • aspiration • chronic obstructive pulmonary disease • gastroesophageal reflux disease • GERD