Diagnosis and treatment of chronic obstructive pulmonary disease associated with gastroesophageal reflux disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Zhitong ¹ , WANG Zhonggao ¹ , HAN Xinwei ¹ , LI Zhen ² , WU Gang ¹ , LI Chunxia ¹ , LI Chengdong ¹ , BAI Linfeng ¹ ,  JI Feng ¹

1. Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;
2. Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding author：

JI Feng, Email: jifenggreat@126.com

Keywords：

gastroesophageal reflux disease; chronic obstructive pulmonary disease; anti-reflux surgery

DOI：

10.7507/1007-9424.202001034

Video：

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Objective To evaluate laparoscopic anti-reflux surgery for treatment of chronic obstructive pulmonary disease (COPD) associated with gastroesophageal reflux disease (GERD).Methods A total of 20 patients with GERD and COPD underwent laparoscopic anti-reflux procedure in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017. The reflux diagnostic questionnaire, pulmonary function, COPD assessment test scale, 24-hour esophageal pH-impedance monitoring and esophageal pressure measurement were performed in all patients. All drug-refractory patients underwent the laparoscopic anti-reflux surgery. After 12 months follow-up, the parameters of COPD and GERD were evaluated again.Results Twenty patients with COPD and GERD were successfully performed laparoscopic anti-reflux surgery, no hernia patch repair patient and death patient occurred. There was no esophageal rupture, bleeding, infection, and other serious postoperative complications. Although 8 patients had the different degree dysphagia and 10 patients had the different degree abdominal distention, they all relieved themselves. Twenty patients with GERD and COPD were followed up for 1 year. Compared with the values before treatment, the GERD symptom score, reflux times, DeMeester score, and COPD assessment test score of the patients were significantly reduced (P<0.05), the lower esophageal sphincter pressure, percentage of forced expiratory volume in one second (FEV1) in the predicted value and FEV1/forced vital capacity (FVC) were significantly increased (P<0.05) after the treatment. According to the grading standard of The Global Initiative for Chronic Obstructive Lung Disease (GOLD), 5 cases of grade Ⅰ, 2 cases of grade Ⅱ and 1 case of grade Ⅲ were cured; 1 case of grade Ⅰ, 4 cases of grade Ⅱ and 4 cases of grade Ⅲ were improved; 1 case of grade Ⅰ, 1 case of grade Ⅱ and 1 case of grade Ⅳ were ineffective. The total effective rate was 85% (17/20).Conclusions COPD is closely related to GERD. Laparoscopic anti-reflux surgery can not only effectively treat GERD, but also markedly improve COPD.

Citation： LI Zhitong, WANG Zhonggao, HAN Xinwei, LI Zhen, WU Gang, LI Chunxia, LI Chengdong, BAI Linfeng, JI Feng. Diagnosis and treatment of chronic obstructive pulmonary disease associated with gastroesophageal reflux disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 546-551. doi: 10.7507/1007-9424.202001034 Copy

1.	Poelmans J, Tack J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 2005, 54(10): 1492-1499.
2.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南. 中华结核和呼吸杂志, 2002, 25(8): 453-460.
3.	Ferrús JA, Zapardiel J, Sobreviela E, et al. Management of gastroesophageal reflux disease in primary care settings in Spain: SYMPATHY I study. Eur J Gastroenterol Hepatol, 2009, 21(11): 1269-1278.
4.	Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut, 2007, 56(12): 1654-1664.
5.	Terada K, Muro S, Sato S, et al. Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation. Thorax, 2008, 63(11): 951-955.
6.	Rascon-Aguilar IE, Pamer M, Wludyka P, et al. Role of gastroesophageal reflux symptoms in exacerbations of COPD. Chest, 2006, 130(4): 1096-1101.
7.	Bor S, Kitapcioglu G, Solak ZA, et al. Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease. J Gastroenterol Hepatol, 2010, 25(2): 309-313.
8.	Liang WT, Wang ZG, Wang F, et al. Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study. BMC Gastroenterol, 2014, 14: 178.
9.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. COPD 诊治指南(2007 年修订版). 继续医学教育, 2007, 21(2): 31-42.
10.	秦鸣放, 赵宏志. 腹腔镜手术治疗胃食管结合部良性疾病的疗效评估. 中华消化外科杂志, 2011, 10(3): 165-167.
11.	李治仝, 季锋, 韩新巍, 等. 食管裂孔疝对腹腔镜下抗反流手术效果的影响. 中华普通外科杂志, 2016, 31(8): 693-694.
12.	Kim GH. How to interpret ambulatory 24 hr esophageal pH monitoring. J Neurogastroenterol Motil, 2010, 16(2): 207-210.
13.	Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol, 2001, 96(1): 52-57.
14.	Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J, 2009, 34(3): 648-654.
15.	柴晶晶, 柳涛, 蔡柏蔷. 慢性阻塞性肺疾病评估测试中文版临床应用意义的评价. 中华结核和呼吸杂志, 2011, 34(4): 256-258.
16.	Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
17.	Mokhlesi B, Morris AL, Huang CF, et al. Increased prevalence of gastroesophageal reflux symptoms in patients with COPD. Chest, 2001, 119(4): 1043-1048.
18.	Casanova C, Baudet JS, del Valle Velasco M, et al. Increased gastro-oesophageal reflux disease in patients with severe COPD. Eur Respir J, 2004, 23(6): 841-845.
19.	Takada K, Matsumoto S, Kojima E, et al. Prospective evaluation of the relationship between acute exacerbations of COPD and gastroesophageal reflux disease diagnosed by questionnaire. Respir Med, 2011, 105(10): 1531-1536.
20.	Lin YH, Tsai CL, Chien LN, et al. Newly diagnosed gastroesophageal reflux disease increased the risk of acute exacerbation of chronic obstructive pulmonary disease during the first year following diagnosis—a nationwide population-based cohort study. Int J Clin Pract, 2015, 69(3): 350-357.
21.	Ruhl CE, Sonnenberg A, Everhart JE. Hospitalization with respiratory disease following hiatal hernia and reflux esophagitis in a prospective, population-based study. Ann Epidemiol, 2001, 11(7): 477-483.
22.	Low DE, Simchuk EJ. Effect of paraesophageal hernia repair on pulmonary function. Ann Thorac Surg, 2002, 74(2): 333-337.
23.	李治仝, 汪忠镐, 吴继敏, 等. 食管裂孔疝与呼吸道症状临床相关性研究. 中华普通外科杂志, 2013, 28(1): 9-11.
24.	汪忠镐, 高翔, 来运刚, 等. 咽喷嘴及 3S 现象:胃食管气道反流的实验研究. 临床误诊误治, 2011, 24(3): 5-7, 111.
25.	Jatakanon A, Lalloo UG, Lim S, et al. Increased neutrophils and cytokines, TNF-alpha and IL-8, in induced sputum of non-asthmatic patients with chronic dry cough. Thorax, 1999, 54(3): 234-237.
26.	Sacco O, Silvestri M, Sabatini F, et al. IL-8 and airway neutrophilia in children with gastroesophageal reflux and asthma-like symptoms. Respir Med, 2006, 100(2): 307-315.
27.	Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest, 2010, 137(2): 326-332.
28.	Eryuksel E, Dogan M, Olgun S, et al. Incidence and treatment results of laryngopharyngeal reflux in chronic obstructive pulmonary disease. Eur Arch Otorhinolaryngol, 2009, 266(8): 1267-1271.
29.	Sasaki T, Nakayama K, Yasuda H, et al. A randomized, single-blind study of lansoprazole for the prevention of exacerbations of chronic obstructive pulmonary disease in older patients. J Am Geriatr Soc, 2009, 57(8): 1453-1457.
30.	Hoppo T, Jarido V, Pennathur A, et al. Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg, 2011, 146(9): 1041-1047.

1. Poelmans J, Tack J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 2005, 54(10): 1492-1499.
2. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南. 中华结核和呼吸杂志, 2002, 25(8): 453-460.
3. Ferrús JA, Zapardiel J, Sobreviela E, et al. Management of gastroesophageal reflux disease in primary care settings in Spain: SYMPATHY I study. Eur J Gastroenterol Hepatol, 2009, 21(11): 1269-1278.
4. Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut, 2007, 56(12): 1654-1664.
5. Terada K, Muro S, Sato S, et al. Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation. Thorax, 2008, 63(11): 951-955.
6. Rascon-Aguilar IE, Pamer M, Wludyka P, et al. Role of gastroesophageal reflux symptoms in exacerbations of COPD. Chest, 2006, 130(4): 1096-1101.
7. Bor S, Kitapcioglu G, Solak ZA, et al. Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease. J Gastroenterol Hepatol, 2010, 25(2): 309-313.
8. Liang WT, Wang ZG, Wang F, et al. Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study. BMC Gastroenterol, 2014, 14: 178.
9. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. COPD 诊治指南(2007 年修订版). 继续医学教育, 2007, 21(2): 31-42.
10. 秦鸣放, 赵宏志. 腹腔镜手术治疗胃食管结合部良性疾病的疗效评估. 中华消化外科杂志, 2011, 10(3): 165-167.
11. 李治仝, 季锋, 韩新巍, 等. 食管裂孔疝对腹腔镜下抗反流手术效果的影响. 中华普通外科杂志, 2016, 31(8): 693-694.
12. Kim GH. How to interpret ambulatory 24 hr esophageal pH monitoring. J Neurogastroenterol Motil, 2010, 16(2): 207-210.
13. Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol, 2001, 96(1): 52-57.
14. Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J, 2009, 34(3): 648-654.
15. 柴晶晶, 柳涛, 蔡柏蔷. 慢性阻塞性肺疾病评估测试中文版临床应用意义的评价. 中华结核和呼吸杂志, 2011, 34(4): 256-258.
16. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
17. Mokhlesi B, Morris AL, Huang CF, et al. Increased prevalence of gastroesophageal reflux symptoms in patients with COPD. Chest, 2001, 119(4): 1043-1048.
18. Casanova C, Baudet JS, del Valle Velasco M, et al. Increased gastro-oesophageal reflux disease in patients with severe COPD. Eur Respir J, 2004, 23(6): 841-845.
19. Takada K, Matsumoto S, Kojima E, et al. Prospective evaluation of the relationship between acute exacerbations of COPD and gastroesophageal reflux disease diagnosed by questionnaire. Respir Med, 2011, 105(10): 1531-1536.
20. Lin YH, Tsai CL, Chien LN, et al. Newly diagnosed gastroesophageal reflux disease increased the risk of acute exacerbation of chronic obstructive pulmonary disease during the first year following diagnosis—a nationwide population-based cohort study. Int J Clin Pract, 2015, 69(3): 350-357.
21. Ruhl CE, Sonnenberg A, Everhart JE. Hospitalization with respiratory disease following hiatal hernia and reflux esophagitis in a prospective, population-based study. Ann Epidemiol, 2001, 11(7): 477-483.
22. Low DE, Simchuk EJ. Effect of paraesophageal hernia repair on pulmonary function. Ann Thorac Surg, 2002, 74(2): 333-337.
23. 李治仝, 汪忠镐, 吴继敏, 等. 食管裂孔疝与呼吸道症状临床相关性研究. 中华普通外科杂志, 2013, 28(1): 9-11.
24. 汪忠镐, 高翔, 来运刚, 等. 咽喷嘴及 3S 现象:胃食管气道反流的实验研究. 临床误诊误治, 2011, 24(3): 5-7, 111.
25. Jatakanon A, Lalloo UG, Lim S, et al. Increased neutrophils and cytokines, TNF-alpha and IL-8, in induced sputum of non-asthmatic patients with chronic dry cough. Thorax, 1999, 54(3): 234-237.
26. Sacco O, Silvestri M, Sabatini F, et al. IL-8 and airway neutrophilia in children with gastroesophageal reflux and asthma-like symptoms. Respir Med, 2006, 100(2): 307-315.
27. Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest, 2010, 137(2): 326-332.
28. Eryuksel E, Dogan M, Olgun S, et al. Incidence and treatment results of laryngopharyngeal reflux in chronic obstructive pulmonary disease. Eur Arch Otorhinolaryngol, 2009, 266(8): 1267-1271.
29. Sasaki T, Nakayama K, Yasuda H, et al. A randomized, single-blind study of lansoprazole for the prevention of exacerbations of chronic obstructive pulmonary disease in older patients. J Am Geriatr Soc, 2009, 57(8): 1453-1457.
30. Hoppo T, Jarido V, Pennathur A, et al. Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation. Arch Surg, 2011, 146(9): 1041-1047.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and treatment of chronic obstructive pulmonary disease associated with gastroesophageal reflux disease

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