Chest
Original ResearchRespiratory InfectionsGastroesophageal Reflux Disease, Acid Suppression, and Mycobacterium avium Complex Pulmonary Disease
Section snippets
Materials and Methods
A prospective cohort of 58 patients (cases) with MAC lung disease was identified by laboratory notification of isolates of MAC in Queensland, Australia between January 1 and December 31, 1999. The protocol (138/98) was approved by the Princess Alexandra Hospital Research Ethics Committee in accordance with the Australian National Health and Medical Research Council guidelines. Consent to participate was sought, and clinical features of the disease (including risk factors, symptoms, radiology,
Results
The details of MAC+ cases and MAC− controls are shown in Table 1. Radiologic details of those with disease (MAC+) are shown in Table 2 and bacteriology in Table 3.
Clinical information about reflux disease was returned for 52 of 58 MAC+ patients. Twenty-three MAC+ patients (44.2%) had a diagnosis of GERD recorded by their treating doctor, compared to 16 MAC− patients (27.6%) [p = 0.019]. Confirmatory evidence was provided in 10 MAC+ patients: 6 patients had positive findings on gastroscopy, and
Discussion
GERD is a common problem in patients with a number of respiratory diseases. The mechanics of coughing and the related reduction in lower esophageal sphincter tone encourage the reflux of gastric contents into the lower esophagus. The lower pH in the distal esophagus has been shown to cause further cough. Hence, proving a connection between GERD and MAC lung disease specifically was likely to be difficult.
Patients in this cohort with pulmonary MAC disease have a higher incidence of GERD than is
ACKNOWLEDGMENT
The authors thank Dr. Chris Coulter and David Dawson from the QLD Mycobacterial Reference Laboratory, Dr. Jenny Robson from Sullivan and Nicolaides Pathology, and Dr. Ross LeFeuvre and Robyn Fraser from Queensland Medical Laboratory for their assistance in providing reports of all mycobacterial isolates during 1999, and subsequent isolates from the patients in this cohort. Clinical support was provided by Dr. Tom Konstantinos and the Queensland TB Control Unit, Brisbane, QLD, Australia, for
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This research was supported by a Research Scholarship from the Princess Alexandra Hospital, South Brisbane, QLD, Australia, and was conducted through the Department of Thoracic Medicine of the Princess Alexandra Hospital.
The authors have no conflicts of interest to declare.