High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD.
BACKGROUND
Gastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of COPD. The aims of this study were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD.


METHODS
Forty-one COPD patients with a mean FEV1 of 24% of predicted underwent dual-probe 24-h esophageal pH monitoring, and 1 patient underwent esophagogastroduodenoscopy.


RESULTS
The prevalence of GERD was 57%. Elevated distal and proximal reflux were 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 receiving acid blockers at the time of their referral, and only one third reported heartburn and/or acid regurgitation during the pH study. Only higher body mass index was predictive of reflux on regression analysis (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.5; p = 0.05).


CONCLUSIONS
GERD 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.
Kempainen
Robert R
RR
Division of Pulmonary, Allergy, and Critical Care, University of Minnesota School of Medicine, MMC 276, 420 Delaware St SE, Minneapolis, MN 55455, USA. kempa001@umn.edu
Savik
Kay
K
Whelan
Timothy P
TP
Dunitz
Jordan M
JM
Herrington
Cynthia S
CS
Billings
Joanne L
JL
D000328:Adult; D000368:Aged; D018450:Disease Progression; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012044:Regression Analysis; D012307:Risk Factors