Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant.

Nancy Y Yang, Alice Parish, Shai Posner, Rahul A Shimpi, Richard K Wood, R Thomas Finn, Deborah A Fisher, Matthew G Hartwig, Jacob A Klapper, John Reynolds, Donna Niedzwiecki, David A Leiman
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引用次数: 1

Abstract

Gastroesophageal reflux disease (GERD) is common in patients who have undergone lung transplantation and is associated with poorer outcomes, but guidelines are lacking to direct management strategies in this population. We assessed the diagnostic yield of impedance metrics compared to pH-metry alone for detecting GERD among lung transplant recipients and evaluated their association with clinical outcomes. We performed a retrospective cohort study of consecutive patients who underwent lung transplantation. Demographic data, acid exposure time (AET), number of reflux episodes, mean nocturnal baseline impedance (MNBI), post-reflux swallowing-induced peristaltic wave index (PSPWI), and clinical outcomes including mortality were collected. The relationship between GERD metrics and clinical outcomes was assessed using Wilcoxon signed-rank test and Fisher's exact test as appropriate. Of the 76 patients studied, 29 (38%) had GERD based on abnormal AET after lung transplantation. One (1.3%) patient had GERD based on elevated number of reflux episodes and abnormal distal MNBI detected GERD in 19 (26%) patients, resulting in 62% sensitivity and 94% specificity. Two (2.6%) patients had normal PSPWI. Patients with low distal MNBI had significantly decreased forced expiratory volume in 1 second (FEV1) at 3-year posttransplant compared to those without low distal MNBI (P = 0.03). Three-year survival was significantly worse among patients with elevated AET (66.7% vs. 89.1%, P = 0.03) but not with low distal MNBI (68.4% vs. 84.3%, P = 0.18). Abnormal AET is more sensitive for detecting GERD than other reflux metrics studied and is associated with survival, suggesting pH-metry alone may be sufficient to guide GERD management after lung transplant.

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酸暴露时间是检测胃食管反流病的敏感指标,与肺移植后的长期生存相关。
胃食管反流病(GERD)在接受肺移植的患者中很常见,并且与较差的预后相关,但缺乏指导这一人群的治疗策略的指南。在肺移植受者中,我们评估了阻抗法与单独ph法检测胃食管反流的诊断率,并评估了它们与临床结果的相关性。我们对连续接受肺移植的患者进行了回顾性队列研究。收集人口统计学数据、酸暴露时间(AET)、反流发作次数、平均夜间基线阻抗(MNBI)、反流后吞咽诱发的肠波指数(PSPWI)以及包括死亡率在内的临床结果。采用Wilcoxon符号秩检验和Fisher精确检验评估GERD指标与临床结果之间的关系。在研究的76例患者中,29例(38%)因肺移植后AET异常发生胃食管反流。1例(1.3%)患者因反流发作次数增加而出现GERD, 19例(26%)患者的远端MNBI检测到GERD异常,敏感性62%,特异性94%。2例(2.6%)患者PSPWI正常。移植后3年,远端MNBI低的患者1秒用力呼气量(FEV1)明显低于远端MNBI低的患者(P = 0.03)。AET升高患者的三年生存率明显较差(66.7%比89.1%,P = 0.03),但远端MNBI低患者的三年生存率较差(68.4%比84.3%,P = 0.18)。异常AET在检测GERD方面比其他研究的反流指标更敏感,并且与生存率相关,提示单独的ph测定可能足以指导肺移植后GERD的治疗。
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