GASTROESOPHAGEAL REELUX ASPIRATION MANAGEMENT—IS THERE A TARNISH ON COLD STEEL?
The authors performed a prospective observational clinical study of 77 patients referred for esophageal evaluation over the 5‐yr period 1976–1981 for persistent respiratory symptoms and suspected aspiration unresponsive to medical therapy. Symptoms included nocturnal cough (n = 51), wheezing (n = 45), daytime cough (n = 42), and recurrent pneumonia (n = 46). Ages were 2 months to 79 yr, 44 male, 33 female. Ten patients were under 10 yr old. Bronchoscopy was been done in all patients. Esophageal symptoms were present in a minority (hearthurn 23%, regurgitation 34%, dysphagia 14%) and rarely altered daily activity or caused patients to seek medical attention. All had esophageal manometry and 24‐h pH monitoring. Manometry was analyzed for motility disorders and defined as simultaneous and/or repetitive contraction in > 20% of swallows. The results of pH studies were analyzed by standard DeMeester criteria (1) and for correlation with pulmonary symptoms. Symptoms were considered reflux induced if they occurred during or within 3 min of an episode. Symptoms were considered to induce reflux if a reflux episode occurred up to 3 min after or during a symptom episode. Seventeen patients had antireflux procedures (16 adults, one child) performed based on the clinical judgement of the physician. Success of surgery was defined as complete resolution of all symptoms. Forty‐four of 77 patients (53%) had increased esophageal acid exposure. The frequency of upright reflux is not specifically reported; most of the acid exposure time appears to have been supine; 15/54 patients with abnormal acid exposure had respiratory symptoms provoked by a reflux episode. Interestingly, 2/23 patients with “normal” esophageal acid exposure also had pulmonary symptoms provoked by a reflux event. Reflux provoked by cough or wheeze was seen in approximately 15%, with the remainder being unrelated. Motility disorders were seen in 35/77 (45%) and was similar in patients with or without abnormal acid exposure. Patients with reflux and abnormal motility demonstrated a direct relationship between frequency of symptoms and the prevalence of abnormal motility. Patients with cough had a higher frequency of reflux, particularly supine, and delayed esophageal clearance (p < 0.05) compared to patients with wheezing. Five of 17 patients postoperatively were complete successes; 14/17 were improved. The absence of a motility disorder was most predictive of a successful outcome (78% vs. 25%, p value not reported). Best results were in patients with reflux‐induced symptoms or those with no correlation with symptoms. As expected, patients with reflux induced by cough or wheezing were not helped by surgery. Copyright © 1991, Wiley Blackwell. All rights reserved
Digital Object Identifier (DOI)
Additional Document Info