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Clinical Investigations: PULMONARY FUNCTION TESTS |

Severe Gastroesophageal Reflux Is Associated With Reduced Carbon Monoxide Diffusing Capacity*

Linda M. Schachter; John Dixon; Robert J. Pierce; Paul O’Brien
Author and Funding Information

*From the Institute for Breathing and Sleep (Drs. Schachter and Pierce), Austin and Repatriation Medical Centre, Heidelberg, VIC, Australia; and the Department of Surgery (Drs. Dixon and O’Brien), Monash University, Alfred Hospital, Melbourne, VIC, Australia.

Correspondence to: Linda Schachter, MBBS, Department of Respiratory Medicine, Austin and Repatriation Medical Centre, Studley Rd, Heidelberg, VIC 3084, Australia; e-mail: lindams@bigpond.com



Chest. 2003;123(6):1932-1938. doi:10.1378/chest.123.6.1932
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Objective: To assess whether severe gastroesophageal reflux (GER) is associated with abnormalities in lung function including measures of lung volume and gas diffusion.

Methods: Data from 147 patients with obesity (body mass index [BMI] range, 31.7 to 70 kg/m2) who presented for obesity surgery was analyzed retrospectively. A questionnaire was completed preoperatively that included a history of GER, frequency and severity of symptoms, investigations, and medications used. A history of lung disease, sleep-disordered breathing, and smoking also was obtained. A physician who was blinded to lung function graded GER severity prospectively by the results of pH monitoring and/or gastroscopy, and medication use. Spirometry, lung volumes, and gas transfer were measured preoperatively.

Results: Patients with severe GER had reduced levels of the diffusing capacity of the lung for carbon monoxide (Dlco) [21.1 mL/min/mm Hg; 95% confidence interval (CI), 18.9 to 23.2], as measured by CO transfer, compared with those patients without GER (26.3 mL/min/mm Hg; 95% CI, 24.4 to 28.2; p = 0.001). This remained significant after adjusting for age, gender, BMI, and smoking history. Gas transfer corrected for lung volume also was reduced in the group with severe GER (4.6 mL/min/mm Hg per L; 95% CI, 4.3 to 4.9) compared to the group without GER (5.3 mL/min/mm Hg per L; 95% CI, 5.1 to 5.5; p = 0.001). There was no significant difference in other measures of lung function.

Conclusions: Severe GER is associated with an impairment of gas exchange. This may be due to microaspiration of gastric acid or fluid into the airways.

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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543