Abnormal bolus reflux on impedance‐pH testing independently predicts 3‐year pulmonary outcome and mortality in pulmonary fibrosis
Background and Aim Gastroesophageal reflux has been associated with idiopathic pulmonary fibrosis (IPF), although the directionality of the relationship has been debated. Data on the value of objective reflux measures in predicting IPF disease progression and mortality remain limited. We aimed to ev...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2023-11, Vol.38 (11), p.1998-2005 |
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| container_title | Journal of gastroenterology and hepatology |
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| creator | Bailey, Mariel E Borges, Lawrence F Goldberg, Hilary J Hathorn, Kelly E Gavini, Sravanya Lo, Wai‐Kit Chan, Walter W |
| description | Background and Aim
Gastroesophageal reflux has been associated with idiopathic pulmonary fibrosis (IPF), although the directionality of the relationship has been debated. Data on the value of objective reflux measures in predicting IPF disease progression and mortality remain limited. We aimed to evaluate the association between multichannel intraluminal impedance and pH testing (MII‐pH) and 3‐year pulmonary outcomes in IPF patients.
Methods
This was a retrospective cohort study of adults with IPF who underwent pre‐lung transplant MII‐pH off acid suppression at a tertiary center. Patients were followed for 3 years after MII‐pH for poor pulmonary outcomes (hospitalization for respiratory exacerbation or death). A secondary analysis was performed using mortality as outcome of interest. Time‐to‐event analyses using Kaplan–Meier and Cox regression were performed to evaluate associations between MII‐pH and poor outcomes.
Results
One hundred twenty‐four subjects (mean age = 61.7 ± 8 years, 62% male) were included. Increased bolus exposure time (BET) on MII‐pH was associated with decreased time to poor pulmonary outcomes and death (log‐ranked P‐value = 0.017 and 0.031, respectively). On multivariable Cox regression analyses controlling for potential confounders including age, sex, smoking history, body mass index, proton pump inhibitor use, baseline pulmonary function, and anti‐fibrotic therapy, increased BET was an independent predictor for poor pulmonary outcomes [hazard ratio 3.18 (95% confidence interval: 1.25–8.09), P = 0.015] and mortality [hazard ratio 11.3 (95% confidence interval: 1.37–63.9), P = 0.025] over 3 years.
Conclusions
Increased BET on MII‐pH is an independent predictor of poor pulmonary outcomes and mortality over 3 years in IPF patients. These findings also support a role for gastroesophageal reflux in IPF disease progression and the potential impact of routine reflux testing and treatment. |
| doi_str_mv | 10.1111/jgh.16325 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10761196</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2854966893</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4095-35c752c5198f087692bc847e4a540a54d29bc407ab6fd8445b9f5f12d00a95ed3</originalsourceid><addsrcrecordid>eNp1kcFuFSEYhYnR2Gt14QsYEje6mBZmYAZWpmm0V9PEja4JA8wtNwyMMFOdnRv3PqNP4q-3NtVEEmDBx8n5z0HoKSUnFNbpfnd1Qtum5vfQhjJGKtqx9j7aEEF5JRsqj9CjUvaEEEY6_hAdNV1LOGdig76d9THlUQfcp7AUnN0Qli84RezHyVkdjfvx9fu0xbMrs4877KN1k4MjzmHFU3bWm7ngBqjV6YynJYwp6rzitMwmjQ7raPGY8qyDn1f4fwcZfJ9T8eUxejDoUNyTm_sYfXzz-sP5trp8f_H2_OyyMoxIXjXcdLw2nEoxENG1su6NYJ1jmjMC29ayB7LTfTtYwRjv5cAHWltCtOTONsfo1UF3WvrRWQNDZB3UlP0IdlTSXv39Ev2V2qVrRUnXUipbUHhxo5DTpwUyUaMvxoWgo0tLUbXgTLatkA2gz_9B92nJEeYDStaiqQWrgXp5oAwkUSD-WzeUqF_tKmhX_W4X2Gd37d-Sf-oE4PQAfPbBrf9XUu8utgfJn9Nws6g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2892832842</pqid></control><display><type>article</type><title>Abnormal bolus reflux on impedance‐pH testing independently predicts 3‐year pulmonary outcome and mortality in pulmonary fibrosis</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Bailey, Mariel E ; Borges, Lawrence F ; Goldberg, Hilary J ; Hathorn, Kelly E ; Gavini, Sravanya ; Lo, Wai‐Kit ; Chan, Walter W</creator><creatorcontrib>Bailey, Mariel E ; Borges, Lawrence F ; Goldberg, Hilary J ; Hathorn, Kelly E ; Gavini, Sravanya ; Lo, Wai‐Kit ; Chan, Walter W</creatorcontrib><description>Background and Aim
Gastroesophageal reflux has been associated with idiopathic pulmonary fibrosis (IPF), although the directionality of the relationship has been debated. Data on the value of objective reflux measures in predicting IPF disease progression and mortality remain limited. We aimed to evaluate the association between multichannel intraluminal impedance and pH testing (MII‐pH) and 3‐year pulmonary outcomes in IPF patients.
Methods
This was a retrospective cohort study of adults with IPF who underwent pre‐lung transplant MII‐pH off acid suppression at a tertiary center. Patients were followed for 3 years after MII‐pH for poor pulmonary outcomes (hospitalization for respiratory exacerbation or death). A secondary analysis was performed using mortality as outcome of interest. Time‐to‐event analyses using Kaplan–Meier and Cox regression were performed to evaluate associations between MII‐pH and poor outcomes.
Results
One hundred twenty‐four subjects (mean age = 61.7 ± 8 years, 62% male) were included. Increased bolus exposure time (BET) on MII‐pH was associated with decreased time to poor pulmonary outcomes and death (log‐ranked P‐value = 0.017 and 0.031, respectively). On multivariable Cox regression analyses controlling for potential confounders including age, sex, smoking history, body mass index, proton pump inhibitor use, baseline pulmonary function, and anti‐fibrotic therapy, increased BET was an independent predictor for poor pulmonary outcomes [hazard ratio 3.18 (95% confidence interval: 1.25–8.09), P = 0.015] and mortality [hazard ratio 11.3 (95% confidence interval: 1.37–63.9), P = 0.025] over 3 years.
Conclusions
Increased BET on MII‐pH is an independent predictor of poor pulmonary outcomes and mortality over 3 years in IPF patients. These findings also support a role for gastroesophageal reflux in IPF disease progression and the potential impact of routine reflux testing and treatment.</description><identifier>ISSN: 0815-9319</identifier><identifier>ISSN: 1440-1746</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.16325</identifier><identifier>PMID: 37605548</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; aspiration ; Body mass index ; Confidence intervals ; Disease Progression ; Electric Impedance ; Esophageal pH Monitoring ; Esophagitis, Peptic ; extra‐esophageal reflux ; Female ; Fibrosis ; Gastroesophageal reflux ; Gastroesophageal Reflux - complications ; Gastroesophageal Reflux - diagnosis ; Humans ; Hydrogen-Ion Concentration ; Idiopathic Pulmonary Fibrosis - complications ; Idiopathic Pulmonary Fibrosis - diagnosis ; lung disease ; Lung diseases ; Lung transplantation ; Male ; Middle Aged ; Mortality ; outcomes ; pH effects ; Proton pump inhibitors ; Pulmonary fibrosis ; Respiratory function ; Retrospective Studies</subject><ispartof>Journal of gastroenterology and hepatology, 2023-11, Vol.38 (11), p.1998-2005</ispartof><rights>2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><rights>2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4095-35c752c5198f087692bc847e4a540a54d29bc407ab6fd8445b9f5f12d00a95ed3</citedby><cites>FETCH-LOGICAL-c4095-35c752c5198f087692bc847e4a540a54d29bc407ab6fd8445b9f5f12d00a95ed3</cites><orcidid>0000-0002-1709-8230</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.16325$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.16325$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37605548$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bailey, Mariel E</creatorcontrib><creatorcontrib>Borges, Lawrence F</creatorcontrib><creatorcontrib>Goldberg, Hilary J</creatorcontrib><creatorcontrib>Hathorn, Kelly E</creatorcontrib><creatorcontrib>Gavini, Sravanya</creatorcontrib><creatorcontrib>Lo, Wai‐Kit</creatorcontrib><creatorcontrib>Chan, Walter W</creatorcontrib><title>Abnormal bolus reflux on impedance‐pH testing independently predicts 3‐year pulmonary outcome and mortality in pulmonary fibrosis</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background and Aim
Gastroesophageal reflux has been associated with idiopathic pulmonary fibrosis (IPF), although the directionality of the relationship has been debated. Data on the value of objective reflux measures in predicting IPF disease progression and mortality remain limited. We aimed to evaluate the association between multichannel intraluminal impedance and pH testing (MII‐pH) and 3‐year pulmonary outcomes in IPF patients.
Methods
This was a retrospective cohort study of adults with IPF who underwent pre‐lung transplant MII‐pH off acid suppression at a tertiary center. Patients were followed for 3 years after MII‐pH for poor pulmonary outcomes (hospitalization for respiratory exacerbation or death). A secondary analysis was performed using mortality as outcome of interest. Time‐to‐event analyses using Kaplan–Meier and Cox regression were performed to evaluate associations between MII‐pH and poor outcomes.
Results
One hundred twenty‐four subjects (mean age = 61.7 ± 8 years, 62% male) were included. Increased bolus exposure time (BET) on MII‐pH was associated with decreased time to poor pulmonary outcomes and death (log‐ranked P‐value = 0.017 and 0.031, respectively). On multivariable Cox regression analyses controlling for potential confounders including age, sex, smoking history, body mass index, proton pump inhibitor use, baseline pulmonary function, and anti‐fibrotic therapy, increased BET was an independent predictor for poor pulmonary outcomes [hazard ratio 3.18 (95% confidence interval: 1.25–8.09), P = 0.015] and mortality [hazard ratio 11.3 (95% confidence interval: 1.37–63.9), P = 0.025] over 3 years.
Conclusions
Increased BET on MII‐pH is an independent predictor of poor pulmonary outcomes and mortality over 3 years in IPF patients. These findings also support a role for gastroesophageal reflux in IPF disease progression and the potential impact of routine reflux testing and treatment.</description><subject>Adult</subject><subject>Aged</subject><subject>aspiration</subject><subject>Body mass index</subject><subject>Confidence intervals</subject><subject>Disease Progression</subject><subject>Electric Impedance</subject><subject>Esophageal pH Monitoring</subject><subject>Esophagitis, Peptic</subject><subject>extra‐esophageal reflux</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - complications</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Idiopathic Pulmonary Fibrosis - complications</subject><subject>Idiopathic Pulmonary Fibrosis - diagnosis</subject><subject>lung disease</subject><subject>Lung diseases</subject><subject>Lung transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>outcomes</subject><subject>pH effects</subject><subject>Proton pump inhibitors</subject><subject>Pulmonary fibrosis</subject><subject>Respiratory function</subject><subject>Retrospective Studies</subject><issn>0815-9319</issn><issn>1440-1746</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFuFSEYhYnR2Gt14QsYEje6mBZmYAZWpmm0V9PEja4JA8wtNwyMMFOdnRv3PqNP4q-3NtVEEmDBx8n5z0HoKSUnFNbpfnd1Qtum5vfQhjJGKtqx9j7aEEF5JRsqj9CjUvaEEEY6_hAdNV1LOGdig76d9THlUQfcp7AUnN0Qli84RezHyVkdjfvx9fu0xbMrs4877KN1k4MjzmHFU3bWm7ngBqjV6YynJYwp6rzitMwmjQ7raPGY8qyDn1f4fwcZfJ9T8eUxejDoUNyTm_sYfXzz-sP5trp8f_H2_OyyMoxIXjXcdLw2nEoxENG1su6NYJ1jmjMC29ayB7LTfTtYwRjv5cAHWltCtOTONsfo1UF3WvrRWQNDZB3UlP0IdlTSXv39Ev2V2qVrRUnXUipbUHhxo5DTpwUyUaMvxoWgo0tLUbXgTLatkA2gz_9B92nJEeYDStaiqQWrgXp5oAwkUSD-WzeUqF_tKmhX_W4X2Gd37d-Sf-oE4PQAfPbBrf9XUu8utgfJn9Nws6g</recordid><startdate>202311</startdate><enddate>202311</enddate><creator>Bailey, Mariel E</creator><creator>Borges, Lawrence F</creator><creator>Goldberg, Hilary J</creator><creator>Hathorn, Kelly E</creator><creator>Gavini, Sravanya</creator><creator>Lo, Wai‐Kit</creator><creator>Chan, Walter W</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1709-8230</orcidid></search><sort><creationdate>202311</creationdate><title>Abnormal bolus reflux on impedance‐pH testing independently predicts 3‐year pulmonary outcome and mortality in pulmonary fibrosis</title><author>Bailey, Mariel E ; Borges, Lawrence F ; Goldberg, Hilary J ; Hathorn, Kelly E ; Gavini, Sravanya ; Lo, Wai‐Kit ; Chan, Walter W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4095-35c752c5198f087692bc847e4a540a54d29bc407ab6fd8445b9f5f12d00a95ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Aged</topic><topic>aspiration</topic><topic>Body mass index</topic><topic>Confidence intervals</topic><topic>Disease Progression</topic><topic>Electric Impedance</topic><topic>Esophageal pH Monitoring</topic><topic>Esophagitis, Peptic</topic><topic>extra‐esophageal reflux</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - complications</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Idiopathic Pulmonary Fibrosis - complications</topic><topic>Idiopathic Pulmonary Fibrosis - diagnosis</topic><topic>lung disease</topic><topic>Lung diseases</topic><topic>Lung transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>outcomes</topic><topic>pH effects</topic><topic>Proton pump inhibitors</topic><topic>Pulmonary fibrosis</topic><topic>Respiratory function</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bailey, Mariel E</creatorcontrib><creatorcontrib>Borges, Lawrence F</creatorcontrib><creatorcontrib>Goldberg, Hilary J</creatorcontrib><creatorcontrib>Hathorn, Kelly E</creatorcontrib><creatorcontrib>Gavini, Sravanya</creatorcontrib><creatorcontrib>Lo, Wai‐Kit</creatorcontrib><creatorcontrib>Chan, Walter W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bailey, Mariel E</au><au>Borges, Lawrence F</au><au>Goldberg, Hilary J</au><au>Hathorn, Kelly E</au><au>Gavini, Sravanya</au><au>Lo, Wai‐Kit</au><au>Chan, Walter W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abnormal bolus reflux on impedance‐pH testing independently predicts 3‐year pulmonary outcome and mortality in pulmonary fibrosis</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2023-11</date><risdate>2023</risdate><volume>38</volume><issue>11</issue><spage>1998</spage><epage>2005</epage><pages>1998-2005</pages><issn>0815-9319</issn><issn>1440-1746</issn><eissn>1440-1746</eissn><abstract>Background and Aim
Gastroesophageal reflux has been associated with idiopathic pulmonary fibrosis (IPF), although the directionality of the relationship has been debated. Data on the value of objective reflux measures in predicting IPF disease progression and mortality remain limited. We aimed to evaluate the association between multichannel intraluminal impedance and pH testing (MII‐pH) and 3‐year pulmonary outcomes in IPF patients.
Methods
This was a retrospective cohort study of adults with IPF who underwent pre‐lung transplant MII‐pH off acid suppression at a tertiary center. Patients were followed for 3 years after MII‐pH for poor pulmonary outcomes (hospitalization for respiratory exacerbation or death). A secondary analysis was performed using mortality as outcome of interest. Time‐to‐event analyses using Kaplan–Meier and Cox regression were performed to evaluate associations between MII‐pH and poor outcomes.
Results
One hundred twenty‐four subjects (mean age = 61.7 ± 8 years, 62% male) were included. Increased bolus exposure time (BET) on MII‐pH was associated with decreased time to poor pulmonary outcomes and death (log‐ranked P‐value = 0.017 and 0.031, respectively). On multivariable Cox regression analyses controlling for potential confounders including age, sex, smoking history, body mass index, proton pump inhibitor use, baseline pulmonary function, and anti‐fibrotic therapy, increased BET was an independent predictor for poor pulmonary outcomes [hazard ratio 3.18 (95% confidence interval: 1.25–8.09), P = 0.015] and mortality [hazard ratio 11.3 (95% confidence interval: 1.37–63.9), P = 0.025] over 3 years.
Conclusions
Increased BET on MII‐pH is an independent predictor of poor pulmonary outcomes and mortality over 3 years in IPF patients. These findings also support a role for gastroesophageal reflux in IPF disease progression and the potential impact of routine reflux testing and treatment.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37605548</pmid><doi>10.1111/jgh.16325</doi><tpages>2005</tpages><orcidid>https://orcid.org/0000-0002-1709-8230</orcidid></addata></record> |
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| subjects | Adult Aged aspiration Body mass index Confidence intervals Disease Progression Electric Impedance Esophageal pH Monitoring Esophagitis, Peptic extra‐esophageal reflux Female Fibrosis Gastroesophageal reflux Gastroesophageal Reflux - complications Gastroesophageal Reflux - diagnosis Humans Hydrogen-Ion Concentration Idiopathic Pulmonary Fibrosis - complications Idiopathic Pulmonary Fibrosis - diagnosis lung disease Lung diseases Lung transplantation Male Middle Aged Mortality outcomes pH effects Proton pump inhibitors Pulmonary fibrosis Respiratory function Retrospective Studies |
| title | Abnormal bolus reflux on impedance‐pH testing independently predicts 3‐year pulmonary outcome and mortality in pulmonary fibrosis |
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