KOAH'LI HASTALARDA GASTROOZAFAGİAL REFLÜ HASTALIĞI SIKLIĞININ SİNTİGRAFİ İLE DEĞERLENDİRİLMESİ

Gastroözafagial reflü (GÖR) hastalığı kronik obstrüktif akciğer hastalığı (KOAH) kliniğini ve semptomatolojiyi etkileyen bir eş zamanlı hastalıktır. Bu çalışmada KOAH'lı hastalarda GÖR hastalığı sıklığını GÖR sintigrafisi ile araştırmak ve solunum fonksiyonları ile ilişkisini ortaya koymak amaçlanmıştır. Çalışma grubuna KOAH, akut alevlenme ve solunum yetmezliği bulunan hastalar, kontrol grubuna kronik solunumsal hastalığı olmayan, GÖR ile uyumlu semptomları olan hastalar alındı. Hastaların semptomları, spirometri ve gastroözafagial reflü sintigrafisi sonuçları kaydedildi. Çalışma grubuna 85, kontrol grubuna 27 hasta alındı. Gastroözafagial reflü ile ilişkili semptomu olan KOAH'lı hastalarda FEV1 değerleri (%28.6) daha düşük idi. Sintigrafi KOAH grubunda %4.7 hastada pozitif iken, kontrol grubunda pozitiflik saptanmadı. KOAH akut alevlenmesi ve solu num yetmezliğinde GÖR sintigrafisi ile ortaya konulan GÖR prevalansı GÖR semptomları olan hastalara göre daha fazla değildir. Gastroözafagial reflü, akut alevlenme ve solunum yetmezliği tablosundaki KOAH'lı hastalarda bir risk faktörü olarak bulunmamıştır.

THE EVALUATION OF THE FREQUENCY OF GASTROESOPHAGEAL REFLUX DISEASE BY SCINTIGRAPHY IN PATIENTS WITH COPD

Gastroesophageal reflux (GER) disease is a concomitant disease that affect the clinical situation and symptomatology in chronic obstructive pulmonary disease (COPD). In this study it was aimed to reveal the frequency of GER disease using GER scintigraphy and mark the relation with respiratory functions. In COPD group, there were patients with COPD, acute exacerbation and respiratory failure, where control group contained patients having symptoms related GER without any chronic respiratory diseases. Symptoms, results of spirometry and GER scintigraphy were assessed. There were 85 patients in COPD group and 27 in control group. FEV1 was lower (28.6%) in COPD patients those with symptoms related with GER. Scintigraphy was positive in 4.7% of COPD patients while there was no positive result in control group. The prevalance of GER diagnosed with GER scintigraphy is not higher in COPD plus acute exacerbation and respiratory failure than those having GER symptoms. Gastroesophageal reflux is not a risk factor in patients with COPD with acute exacerbation and respiratory failure.

___

  • 1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2001, 2006.
  • 2. Carverley PM. The GOLD classification has advenced understanding of COPD. Am J Respir Crit Care Med. 2004; 170: 211-2, discussion 214.
  • 3. Mirici A. Tan›mdan Tedaviye Kronik Obstrüktif Akci¤er Hastal›¤›. (ed) Bilgiç H, Karada¤ M. Toraks Kitaplar›, 2008: 6: 1-9.
  • 4. Çavufloglu H. Gastroözofagiyal reflü hastal›¤›. In: Memik F (ed). Klinik Gastroenteroloji 2005: 79-93.
  • 5. Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ. Mechanism of gastroeosophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 1980; 65: 256-67.
  • 6. Wienbeck M, Barnert J. Epidemiology of reflux disease and reflux esophagitis. Scand J Gastroenterol Suppl 1989; 156: 7-13.
  • 7. Richter JE, Castell DO. Gastroesophageal reflux: Pathogenesis, diagnosis, and therapy. Ann Intern Med 1982; 97: 93-103.
  • 8. Ahtaridis G, Snape WJ, Cohen S. Clinical and manometric findings in benign peptic strictures of the esophagus. Dig Dis Sci 1979; 24: 858- 61.
  • 9. Antonia A. Clinical course of chronic obstructive pulmonary disease: Review of the therapeutic interventions. AJRCCM 2006; 119: 46-53.
  • 10. Mannino DM. COPD: epidemilogy, prevalence, morbidity and mortality, and disease heterogeneity. Chest 2002; 121: 121-6S.
  • 11. Sin DD, Man SF. Chronic obstructive pulmonary disease: a novel risk factor for cardiovascular disease.. Can J Physiol Pharmacol 2005; 83: 8-13.
  • 12. Sin DD, A nthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006: 28: 1245-57.
  • 13. El-Serag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology 1997; 113: 755-60.
  • 14. Boyle JT, Tuchman DN, Altschuler SM, Nixon TE, Pack AI, Cohen S. Mechanisms for the association of gastroesophageal reflux and bronchospasm. Am Rev Respir Dis 1985; 131: 16-20.
  • 15. Mansfield LE, Stein MR. Gastroesophageal reflux and asthma. A possible reflex mechanism. Ann Allergy 1978; 41: 224-6.
  • 16. Field SK, Underwood M, Brant R, Cowie RL. Prevalence of gastroesophageal reflux symptoms in asthma. Chest 1996; 109: 316-22.
  • 17. Stein MR, Towner TG, Weber RW, Mansfield LE, Jacobson KW, McDonnell JT, Nelson HS. The effect of theophylline on the lower esophageal sphincter pressure. Ann Allergy 1980; 45: 238-41.
  • 18. Berquist WE, Rachelefsky GS, Kadden M, Siegel SC, Katz RM, Mickey MR, Ament ME. Effect of theophylline on gastroesophageal reflux in normal adults. J Allergy Clin Immunol 1981; 67: 407-11.
  • 19. Hetzel DJ, Dent J, Reed WD, Narielvala FM, Mackinnon M, McCarthy JH, Mitchell B, Beveridge BR, Laurence BH, Gibson GG. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology 1988; 95: 903-12.
  • 20. Casanova C, Baudet JS, del Valle Velasco M, Martin JM, Aguirre-Jaime A, de Torres JP, Celli BR. Increased gastro-oesophageal reflux disease in patients with severe COPD. Eur Respir J 2004; 23: 841-5.