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.