Gastroesophageal reflux (symptomatic and silent): a potentially significant problem in patients with cystic fibrosis before and after lung transplantation.
BACKGROUND
The significance of gastroesophageal reflux (GER) and aspiration are unclear in cystic fibrosis (CF) and may contribute to declining lung function before and after lung transplantation (LTx).


METHODS
We sought to establish whether GER occurs in patients with CF on the LTx waiting list and after LTx. We then investigated whether GER correlates with patients' symptoms. Adults with CF on the waiting list and after LTx were prospectively recruited. Completion of a valid, structured symptom questionnaire was followed by ambulatory, dual-probe, 24-hour esophageal pH monitoring.


RESULTS
Twenty-four patients were studied, including 11 (6 males) in the pre-LTx group and 13 (9 males) in the post-LTx group. The pre-LTx group was 29.3 +/- 8.2 years of age, and the post-LTx group was 32.7 +/- 8.2 years of age. DeMeester score (normal value <14.7) was 36.6 +/- 22.3 for the pre-LTx group and 40.0 +/- 37.3 for the post-LTx group. Proximal esophageal acid exposure was significantly higher in both CF groups compared with normal. Symptom scores (normal <4, range -2 to 18) were: pre-LTx group, 5.8 +/- 6.5; post-LTx group, 7.7 +/- 5.4. Percent forced expiratory volume in 1 second (FEV1%) predicted was: pre-LTx group, 31.3 +/- 7.8; post-LTx group, 65.2 +/- 29.3. In the pre-LTx group, 10 of 11 (90.9%) patients had significant GER on monitoring, including 4 (40%) with symptomatic GER and 6 (60%) with silent GER. In the post-LTx group, 11 of 13 (84.6%) had significant GER on monitoring, including 9 (82%) with symptomatic GER and 2 (18%) with silent GER.


CONCLUSIONS
GER, symptomatic and silent, is a significant problem in CF. This condition should be aggressively treated and surgery should be considered if GER persists on re-testing.
Button
Brenda M
BM
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Melbourne, Australia. b.button@alfred.org.au
Roberts
Stuart
S
Kotsimbos
Tom C
TC
Levvey
Bronwyn J
BJ
Williams
Trevor J
TJ
Bailey
Michael
M
Snell
Gregory I
GI
Wilson
John W
JW
D000293:Adolescent; D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003938:Diagnostic Techniques, Digestive System; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011446:Prospective Studies; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires