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W1826 Objective Recording of Cough Associated to Gastroesophageal Reflux
questions) and asthma/bronchitis (7 questions). The other 5 questions were handled as single question subscales. Mean scores for all subscales were significantly (p<0,01) higher in patients than in controls. Sleeplessness scores correlated significantly to the subjective sleep quality subscale (r=0,63) and the daytime dysfunction subscale (r=0,50) in the PSQI, but not with the overall ESS score (r=0,11). Snoring correlated significantly both to the ESS (r=0,50), and to the PSQI (r = 0,59 and 0,83). CONCLUSION. The new self-administered RASQ appears to be well suited for measuring airway symptoms and sleep disturbances in patients with GERD. W1825 Quantification of Dental Erosions in GERD Using Optical Coherence Tomography (OCT): An Interventional Placebo-Controlled Study with Esomeprazole Petra E. Wilder-Smith, Clive H. Wilder-Smith, Hilari Kawakami-Wong, Julia Voronets, Kathy Osann, Adrian Lussi Dental erosion, the chemical dissolution of enamel without bacterial involvement, is an underreported yet rapidly increasing manifestation of GERD leading to loss of tooth substance, hypersensitivity, functional impairment and even tooth fracture. To date, dental erosions have only been assessed using very basic visual methods and no guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions. In this randomized, double-blind study we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg bid or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions (Lussi erosion index >1) and an abnormal acid exposure by 24h esophageal pH-manometry (defined as >4% of 24h period with pH<4). Enamel and dentin thickness, reflectivity and absorbance were measured by OCT (Niris®, Imalux, USA) pre- and post-therapy at identical localizations on teeth with most severe visible erosions as well as multiple other predefined teeth. The mean ± SD difference in enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2±1.3μm with esomeprazole and 15.25±2.8μm with placebo (p=0.013), representing a loss of 0.3% and 0.8% of total enamal thickness, respectively. The change in optical reflectivity to a depth of 25μm after treatment was -1.122 dB with esomeprazole and +2.059 dB with placebo (p=0.012), with increased reflectivity signifying demineralization. OCT non-invasively detected and quantified significant differences in the progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20mg bid versus placebo. This suggests esomeprazole may be useful in preventing progression of GERD-related dental erosions. Further validation of preventative treatment regimens using this sensitive detection method is required, including correlation with quantitative reflux measures.
W1823 Aspiration of Gastric Components in Lung Transplant Recipients: Do Bile Acids Account for the Inflammatory Reaction? Veerle Mertens, Kathleen Blondeau, Ans Pauwels, Robin Vos, Bart M. Vanaudenaerde, Dirk E. Van Raemdonck, Geert M. Verleden, Lieven Dupont, Daniel Sifrim Acid gastroesophageal reflux and aspiration of gastric components have been implicated as a potential non-alloimmune cause of lung allograft injury after lung transplantation. Bile acids have been found to be more prevalent in the BALF of LTx patients with BOS and it is shown that IL-8 is increased in the BALF of these patients. The aim of this study was to evaluate if bile acids are the most potent components in the gastric juice to produce IL-8 by human bronchial epithelial cells (HBEC). Methods: Bronchial epithelial cells were exposed for 24 hrs at pH 6-7.2 to bile acids (100 nM), gastric juice (1/1000) and pepsin (2000 ng/ ml). IL-1β was used as a positive control. IL-8 concentrations were measured in the supernatants with ELISA. Results: Exposure of HBEC to bile acids (TDA or TDCA) did not induce a significant increase in IL-8 production [41 pg/ml (35-48)]. Stimulation with pepsin slightly but significantly increased IL-8 levels [105 pg/ml (97-123)]. Gastric juice resulted in a significantly increased IL-8 production in HBEC In Vitro [(190 pg/ml (36-471) vs 0 pg/ml (0-18);p<0.05], to a larger extent than pepsin did. Conclusion: Bile acids did not induce a significant IL-8 production in human bronchial epithelial cells In Vitro. Neither bile acids nor pepsin can explain the pro-inflammatory effect induced by gastric juice. We hypothesize that other components of the gastric juice such as bacterial products, pancreatic enzymes i.e. trypsin might be responsible for the pro inflammatory effect which might predispose to the development of BOS.
W1826 Objective Recording of Cough Associated to Gastroesophageal Reflux Ans Pauwels, Kathleen Blondeau, Veerle Mertens, Lieven Dupont, Daniel Sifrim Introduction: A close temporal association between acid or non-acid gastroesophageal reflux and cough can be helpful for identification and treatment of patients with reflux-related unexplained chronic cough. Reflux events can be precisely detected with impedance-ph monitoring. In contrast, methods for cough recording during reflux monitoring have not been very accurate so far i.e. diary or event marker pressed by the patient. More recently, studies used simultaneous gastro-esophageal manometry to detect a cough induced typical pressure pattern. The aim of this study was to validate the manometric cough detection technique for precise assessment of the reflux-cough association. Methods: 7 chronic cough patients [3 men, median age 60 (45-71)] were studied using impedance-pH manometry monitoring. The separate parallel manometric catheter contained two solid-state pressure sensors (1 gastric, 1 esophageal) (Sandhill Sci). Cough was defined as two or more rapid pressure rises within 3 seconds occurring simultaneously and with the same pressure configuration at both manometric recording sites. Studies were performed in stationary conditions. For validation purposes, simultaneous video-imaging of patient movement and sound recordings were obtained during the whole cough-reflux monitoring period. Patients were asked to press an event marker in case of cough. Impedance-pH, manometric cough and videosound recordings were analyzed independently. Results: The mean time of measurement was 252 minutes (244-271). The total number of coughs detected by manometry was 139 [19.9, (6-51)] and by video-sound recording 156 [22.3, (7-56)]. 136/139 manometrically detected coughs were confirmed on video. In 1 patient, 3 episodes of nose blowing appeared as cough on the manometry tracing. 13 % of the total number of coughs detected on videosound were single coughs not considered by definition using the manometric method. None of them was marked by the patients or was associated with reflux. In total we found 23 manometric single peaks similar to those present in cough bursts. 10 of them were cough on video-sound and the other 13 were either throat clearing, vomiting or sneezing. Conclusion: Manometric cough detection is a simple and reliable technique to asses the precise time association between gastroesophageal reflux and cough. Using pressure peaks bursts as criteria for cough definition will miss a low percentage of single cough episodes. However, single cough episodes were not troublesome for the patient and were never associated with reflux events.
Figure 1: IL-8 production by human bronchial epithelial cells exposed to gastric juice (GJ), bile acids (100nM) and pepsin 2000 ng/ml. W1824 Validation of a Questionnaire On Airway Symptoms and Sleeping Difficulties in Patients with Gastroesophageal Reflux Disease - the Reflux, Airway and Sleep Questionnaire (RASQ) Rune Johannessen, Hermod Petersen, Malcolm Sue-Chu, Anne K. Aasebøstøl, Ingard Løge, Per M. Kleveland BACKGROUND. Atypical symptoms in patients with gastroesophageal reflux disease (GERD) are important. This study validates a new questionnaire dealing with such symptoms. MATERIAL AND METHODS. The Reflux, Airway and Sleep Questionnaire (RASQ) is selfadministered, asks about 18 symptoms possibly related to GERD answered on a 7-point Likert scale and with a one year recall period. Higher scores indicate worse symptoms. There are questions about heartburn/regurgitation, sleeplessness, snoring, pneumonia and upper airway infections, as well as on various bronchial and laryngeal symptoms. The study included 305 patients having been diagnosed with either GERD (65), laryngitis (32), asthma (30), chronic obstructive pulmonary disease (COPD) (45), acute bronchitis (39), pneumonia (42) or upper airway infection (52) during the last year, and 708 matched controls. Criterion validity was based on a comparison between patients and controls. Criterion validity for sleeplessness and snoring were tested using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Test-retest reliability was examined in patients with stable GERD. RESULTS. The response rate was 64% for patients and 55% for controls. Testretest reliability and Cronbach's alpha were satisfactory, with coefficients ranging between 0,75-0,97 and 0,88-0,92, respectively. Overall mean RASQ score was 2,35 for patients and 1,70 for controls (p<0,001). Factor analysis revealed two subscales; laryngopharyngitis (6
W1827 Globus Sensation Is Caused By a Vagal Reflex Due to Gastroesophageal Reflux with UES Pressure Elevation Ryoji Tokashiki, Nobutishi Funato Objectives: Several recent studies have shown that globus sensations are related to hypertonicity of the upper esophageal sphincter (UES) pressure. An increase in the UES pressure following acid infusion into the esophagus has also been reported. Based on these findings, we hypothesized that gastroesophageal reflux raises UES pressure and thus triggers globus
A-733
AGA Abstracts
AGA Abstracts
Twenty-two of 44 LTR (50%) had an abnormal pH study (% time with pH < 4 of > 4.2%). Of those with abnormal studies, median age was 40 yrs, 63% were male and 86% had a primary diagnosis of cystic fibrosis (n=19). Twelve of the 22 (54 %) with an abnormal pH study had ARS. Within the surgery cohort, median age was 44 yrs, 53% were male, 83% (n=10) had a primary diagnosis of cystic fibrosis and the average acid exposure time was 10%. The patients who had acidic reflux but declined Nissen also had an average acid exposure time of 10%. The average time from transplant to ARS was 34 months (std dev 12). The mean follow up post ARS was 11 months (std dev 9). Prior to ARS, there was no significant difference in lung function in those patients with reflux who had ARS versus those with reflux who did not have ARS. ARS did not improve lung function based on change in FEV1 or decrease the rate of decline in lung function over time. Additionally, ARS had no mortality benefit. Of the LTR with ARS, two died in follow up, two had progression of their lung disease and eight had no change. In those declining ARS, 1 died and the other nine had progression of disease at the same rate as the LTR with ARS. Conclusion: GER is highly prevalent among recipients of lung transplant. Our study found no benefit in anti-reflux surgery in lung transplant patients with documented reflux. The potential benefit of anti-reflux surgery in the lung transplant population is unclear and should be weighed against the risks of the procedure.
W1823 Aspiration of Gastric Components in Lung Transplant Recipients: Do Bile Acids Account for the Inflammatory Reaction? Veerle Mertens, Kathleen Blondeau, Ans Pauwels, Robin Vos, Bart M. Vanaudenaerde, Dirk E. Van Raemdonck, Geert M. Verleden, Lieven Dupont, Daniel Sifrim Acid gastroesophageal reflux and aspiration of gastric components have been implicated as a potential non-alloimmune cause of lung allograft injury after lung transplantation. Bile acids have been found to be more prevalent in the BALF of LTx patients with BOS and it is shown that IL-8 is increased in the BALF of these patients. The aim of this study was to evaluate if bile acids are the most potent components in the gastric juice to produce IL-8 by human bronchial epithelial cells (HBEC). Methods: Bronchial epithelial cells were exposed for 24 hrs at pH 6-7.2 to bile acids (100 nM), gastric juice (1/1000) and pepsin (2000 ng/ ml). IL-1β was used as a positive control. IL-8 concentrations were measured in the supernatants with ELISA. Results: Exposure of HBEC to bile acids (TDA or TDCA) did not induce a significant increase in IL-8 production [41 pg/ml (35-48)]. Stimulation with pepsin slightly but significantly increased IL-8 levels [105 pg/ml (97-123)]. Gastric juice resulted in a significantly increased IL-8 production in HBEC In Vitro [(190 pg/ml (36-471) vs 0 pg/ml (0-18);p<0.05], to a larger extent than pepsin did. Conclusion: Bile acids did not induce a significant IL-8 production in human bronchial epithelial cells In Vitro. Neither bile acids nor pepsin can explain the pro-inflammatory effect induced by gastric juice. We hypothesize that other components of the gastric juice such as bacterial products, pancreatic enzymes i.e. trypsin might be responsible for the pro inflammatory effect which might predispose to the development of BOS.
W1826 Objective Recording of Cough Associated to Gastroesophageal Reflux Ans Pauwels, Kathleen Blondeau, Veerle Mertens, Lieven Dupont, Daniel Sifrim Introduction: A close temporal association between acid or non-acid gastroesophageal reflux and cough can be helpful for identification and treatment of patients with reflux-related unexplained chronic cough. Reflux events can be precisely detected with impedance-ph monitoring. In contrast, methods for cough recording during reflux monitoring have not been very accurate so far i.e. diary or event marker pressed by the patient. More recently, studies used simultaneous gastro-esophageal manometry to detect a cough induced typical pressure pattern. The aim of this study was to validate the manometric cough detection technique for precise assessment of the reflux-cough association. Methods: 7 chronic cough patients [3 men, median age 60 (45-71)] were studied using impedance-pH manometry monitoring. The separate parallel manometric catheter contained two solid-state pressure sensors (1 gastric, 1 esophageal) (Sandhill Sci). Cough was defined as two or more rapid pressure rises within 3 seconds occurring simultaneously and with the same pressure configuration at both manometric recording sites. Studies were performed in stationary conditions. For validation purposes, simultaneous video-imaging of patient movement and sound recordings were obtained during the whole cough-reflux monitoring period. Patients were asked to press an event marker in case of cough. Impedance-pH, manometric cough and videosound recordings were analyzed independently. Results: The mean time of measurement was 252 minutes (244-271). The total number of coughs detected by manometry was 139 [19.9, (6-51)] and by video-sound recording 156 [22.3, (7-56)]. 136/139 manometrically detected coughs were confirmed on video. In 1 patient, 3 episodes of nose blowing appeared as cough on the manometry tracing. 13 % of the total number of coughs detected on videosound were single coughs not considered by definition using the manometric method. None of them was marked by the patients or was associated with reflux. In total we found 23 manometric single peaks similar to those present in cough bursts. 10 of them were cough on video-sound and the other 13 were either throat clearing, vomiting or sneezing. Conclusion: Manometric cough detection is a simple and reliable technique to asses the precise time association between gastroesophageal reflux and cough. Using pressure peaks bursts as criteria for cough definition will miss a low percentage of single cough episodes. However, single cough episodes were not troublesome for the patient and were never associated with reflux events.
Figure 1: IL-8 production by human bronchial epithelial cells exposed to gastric juice (GJ), bile acids (100nM) and pepsin 2000 ng/ml. W1824 Validation of a Questionnaire On Airway Symptoms and Sleeping Difficulties in Patients with Gastroesophageal Reflux Disease - the Reflux, Airway and Sleep Questionnaire (RASQ) Rune Johannessen, Hermod Petersen, Malcolm Sue-Chu, Anne K. Aasebøstøl, Ingard Løge, Per M. Kleveland BACKGROUND. Atypical symptoms in patients with gastroesophageal reflux disease (GERD) are important. This study validates a new questionnaire dealing with such symptoms. MATERIAL AND METHODS. The Reflux, Airway and Sleep Questionnaire (RASQ) is selfadministered, asks about 18 symptoms possibly related to GERD answered on a 7-point Likert scale and with a one year recall period. Higher scores indicate worse symptoms. There are questions about heartburn/regurgitation, sleeplessness, snoring, pneumonia and upper airway infections, as well as on various bronchial and laryngeal symptoms. The study included 305 patients having been diagnosed with either GERD (65), laryngitis (32), asthma (30), chronic obstructive pulmonary disease (COPD) (45), acute bronchitis (39), pneumonia (42) or upper airway infection (52) during the last year, and 708 matched controls. Criterion validity was based on a comparison between patients and controls. Criterion validity for sleeplessness and snoring were tested using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Test-retest reliability was examined in patients with stable GERD. RESULTS. The response rate was 64% for patients and 55% for controls. Testretest reliability and Cronbach's alpha were satisfactory, with coefficients ranging between 0,75-0,97 and 0,88-0,92, respectively. Overall mean RASQ score was 2,35 for patients and 1,70 for controls (p<0,001). Factor analysis revealed two subscales; laryngopharyngitis (6
W1827 Globus Sensation Is Caused By a Vagal Reflex Due to Gastroesophageal Reflux with UES Pressure Elevation Ryoji Tokashiki, Nobutishi Funato Objectives: Several recent studies have shown that globus sensations are related to hypertonicity of the upper esophageal sphincter (UES) pressure. An increase in the UES pressure following acid infusion into the esophagus has also been reported. Based on these findings, we hypothesized that gastroesophageal reflux raises UES pressure and thus triggers globus
A-733
AGA Abstracts
AGA Abstracts
Twenty-two of 44 LTR (50%) had an abnormal pH study (% time with pH < 4 of > 4.2%). Of those with abnormal studies, median age was 40 yrs, 63% were male and 86% had a primary diagnosis of cystic fibrosis (n=19). Twelve of the 22 (54 %) with an abnormal pH study had ARS. Within the surgery cohort, median age was 44 yrs, 53% were male, 83% (n=10) had a primary diagnosis of cystic fibrosis and the average acid exposure time was 10%. The patients who had acidic reflux but declined Nissen also had an average acid exposure time of 10%. The average time from transplant to ARS was 34 months (std dev 12). The mean follow up post ARS was 11 months (std dev 9). Prior to ARS, there was no significant difference in lung function in those patients with reflux who had ARS versus those with reflux who did not have ARS. ARS did not improve lung function based on change in FEV1 or decrease the rate of decline in lung function over time. Additionally, ARS had no mortality benefit. Of the LTR with ARS, two died in follow up, two had progression of their lung disease and eight had no change. In those declining ARS, 1 died and the other nine had progression of disease at the same rate as the LTR with ARS. Conclusion: GER is highly prevalent among recipients of lung transplant. Our study found no benefit in anti-reflux surgery in lung transplant patients with documented reflux. The potential benefit of anti-reflux surgery in the lung transplant population is unclear and should be weighed against the risks of the procedure.