Prevalence of Gastroesophageal Reflux Disease in Patients With Nontuberculous Mycobacterial Lung Disease

doi:10.1378/chest.06-2280

Chest

Volume 131, Issue 6, June 2007, Pages 1825-1830

https://doi.org/10.1378/chest.06-2280 Get rights and content

Background

Knowledge of the relationship between respiratory disorders and gastroesophageal reflux disease (GERD) is increasing. However, the association between GERD and pulmonary disease caused by nontuberculous mycobacteria (NTM) has not been studied in detail. We investigated the prevalence of GERD in patients with the nodular bronchiectatic form of NTM lung disease.

Methods

Fifty-eight patients with the nodular bronchiectatic form of NTM lung disease underwent ambulatory 24-h esophageal pH monitoring. Of the 58 patients, 27 patients were identified as having Mycobacterium avium complex infection (15 with Mycobacterium intracellulare and 12 with M avium), and 31 patients had Mycobacterium abscessus pulmonary infection.

Results

The prevalence of GERD in patients with the nodular bronchiectatic form of NTM lung disease was 26% (15 of 58 patients). Only 27% (4 of 15 patients) had typical GERD symptoms. No statistically significant differences were found between patients with GERD and those without GERD with regard to age, sex, body mass index, or pulmonary function test results. However, patients with GERD were more likely to have a sputum smear that was positive for acid-fast bacilli (12 of 15 patients, 80%), compared with patients without GERD (19 of 43 patients, 44%) [p = 0.033]. In addition, bronchiectasis and bronchiolitis were observed in more lobes in patients with GERD than in patients without GERD (p = 0.008 and p = 0.005, respectively).

Conclusions

Patients with the nodular bronchiectatic form of NTM lung disease have a high prevalence of increased esophageal acid exposure, usually without typical GERD symptoms.

Section snippets

Patients

We screened consecutive patients with the nodular bronchiectatic form of NTM lung disease who were evaluated in the NTM lung disease clinic at the Samsung Medical Center (a 1,250-bed referral hospital in Seoul, Korea) during the 24-month period from January 2004 to December 2005. The diagnosis of NTM lung disease was made based on the diagnostic criteria published by the American Thoracic Society.¹ All patients had characteristic findings such as multifocal bronchiectasis combined with multiple

Results

We screened 92 consecutive patients with the nodular bronchiectatic form of NTM lung disease. Five patients who were > 75 years old were excluded from this study. Twenty patients refused to participate in the study. Of the 67 patients who agreed to participate, 9 patients were excluded due to problems in placing the pH catheter, such as increased cough or dyspnea. Ultimately, we analyzed the data from 58 patients who completed the 24-h esophageal pH monitoring. The only difference between the

Discussion

In this study using ambulatory esophageal pH monitoring, we made some important findings. First, there was a high prevalence of GERD in patients with NTM lung disease. Second, GERD can be present in patients with NTM lung disease without typical reflux symptoms such as heartburn or acid regurgitation. Third, the presence of GERD was associated with sputum AFB-positive smear results in patients with NTM lung disease. In addition, the involvement of bronchiectasis and bronchiolitis on HRCT was

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Citation Excerpt :
Because the incidence of NTM PD in the Korean population ranged from 6 to 19 cases per 100,000 per year between 2008 and 2016 in a previous study,4 the GERD-related disease burden of incident NTM PD seems to be substantial. Further evidence supports a close relationship between GERD and NTM PD in terms of prevalence and disease presentation in previous studies.6,8,9 In addition to showing cross-sectional association between GERD and NTM PD, the temporal relationship between GERD and NTM PD was clarified in the present study.
Gastroesophageal reflux disease (GERD) is a common comorbidity of nontuberculous mycobacteria (NTM) pulmonary disease (PD). Although GERD is associated with more symptoms and severe disease in patients with NTM PD, whether GERD is associated with an increased risk of NTM PD developing is unknown.
Does GERD influence the development of NTM PD? Are there any factors associated with an increased risk of NTM PD among patients with GERD? What is the impact of NTM PD on the health-care use of patients with GERD?
Data from the Korean National Health Insurance Service National Sample Cohort between 2002 and 2015 were used. The incidence and risk of NTM PD were compared between patients with GERD (GERD cohort; n = 17,424) and patients matched for age, sex, type of insurance, and Charlson Comorbidity Index (matched cohort; n = 69,696). Using the GERD cohort, the factors associated with incident NTM PD also were evaluated.
During a median follow-up duration of 5.1 years, the age- and sex-adjusted incidence of NTM PD was significantly higher in the GERD cohort (34.8 per 100,000 person-years [PY]) than in the matched cohort (10.5 per 100,000 PY; P < .001), with a subdistribution hazard ratio (HR) of 3.36 (95% CI, 2.10-5.37). Regarding risk factors associated with NTM PD, age of 60 years or older (adjusted HR, 3.57; 95% CI, 1.58-8.07) and bronchiectasis (adjusted HR, 18.69; 95% CI, 6.68-52.28) were associated with an increased risk of incident NTM PD in the GERD cohort. Compared with patients with GERD who did not demonstrate NTM PD, those with NTM PD showed higher all-cause (13,321 PY vs 5,932 PY; P = .049) and respiratory disease-related (5,403 vs 801; P = .011) ED visits or hospitalizations.
GERD is associated with an increased incidence of NTM PD. Older age and bronchiectasis are risk factors for NTM PD in patients with GERD. NTM PD in patients with GERD is associated with increased health-care use.
Nontuberculous Mycobacterial Pulmonary Disease: Clinical Epidemiologic Features, Risk Factors, and Diagnosis: The Nontuberculous Mycobacterial Series
2022, Chest
Nontuberculous mycobacterial pulmonary disease (NTM-PD) continues to impose a significant clinical burden of disease on susceptible patients. The incidence of NTM-PD is rising globally, but it remains a condition that is challenging to diagnose and treat effectively. This review provides an update on the global epidemiologic features, risk factors, and diagnostic considerations associated with the management of NTM-PD.
Host immune response against environmental nontuberculous mycobacteria and the risk populations of nontuberculous mycobacterial lung disease
2020, Journal of the Formosan Medical Association
Citation Excerpt :
The normal mucosa of the bronchial epithelium is broken once gastric juice has been aspirated, and chronic bronchial inflammation ensues. Recent studies have reported that 26%–44% of patients with NTM-LD have GERD, and GERD is more common in patients with NTM than in people without NTM.76,77 Of patients with MAC-LD, aspiration was suspected in 15.5%—higher than that in patients without MAC-LD.76
Nontuberculous mycobacterial lung disease (NTM-LD) prevalence has been increasing over the recent decades. Numerous host factors are associated with NTM-LD development, including susceptible phenotypes such as ciliary defect and lung structural change, pulmonary clearance defect with poor clearance of secretions, and immune suppression. Specifically, regarding the susceptible host phenotypes without clear pathogenesis, a slender body, pectus excavatum, and postmenopausal female status are common. Also, decreased host immunity to NTM, especially T helper 1 cell responses is frequently observed. Even so, the underlying mechanisms remain unclear and relevant large-scale studies are lacking. Infections due to host genetics associated defects are mostly untreatable but rare in Asia, particularly Taiwan. Nevertheless, some risks for NTM-LD are controllable over disease progression. We suggest that clinicians first manage host factors and deal with the controllable characteristics of NTM-LD, followed by optimizing anti-NTM treatment. Further researches focusing on NTM-LD pathogenesis, especially the host–NTM interaction may advance understanding the nature of the disease and develop efficient therapeutic regimens.
Clinical outcomes in Mycobacterium xenopi versus Mycobacterium avium complex pulmonary disease: A retrospective matched cohort study
2020, Respiratory Medicine
Mycobacterium xenopi is associated with the highest mortality among pulmonary nontuberculous mycobacterial (NTM) infections, but whether this is due to the infection or other factors is unclear. There is little information regarding outcomes among patients infected with M. xenopi versus other NTM species.
We conducted a retrospective matched cohort study comparing M. xenopi pulmonary disease (Mx-PD) to M. avium complex (MAC)-PD. Patients were matched by sex, age, radiologic subtype, and presence of cavitation. Baseline clinical characteristics, treatment, and outcomes were compared using matched analyses.
We identified 70 Mx-PD cases: 29 fibrocavitary-type, 28 nodular-bronchiectatic-type, and 13 unclassifiable-type CT patterns, mean (SD) age 63 (13) years, and 54.3% (n = 38) female. Median follow-up duration was longer in the Mx-PD cohort (1552 days versus 1035 days, p = 0.01). Symptoms, radiologic phenotype, and pulmonary function were similar between groups although the Charlson Comorbidity Index was numerically higher in Mx-PD patients (3.6 versus 3.2, p = 0.08). Rifamycins were used less frequently in Mx-PD (59.5% versus 85.7%, p = 0.02). Although combined clinical and radiologic improvement was similar between the groups, successful treatment was more common with Mx-PD (40.5% versus 16.7%, p = 0.02) owing to superior culture conversion (70.8% versus 33.3%, p = 0.0001). Mortality 24 months after initiation of treatment was numerically but not statistically greater in the Mx-PD cohort (20.4% versus 10.3%, p = 0.32).
Among matched Mx-PD and MAC-PD patients, standard anti-mycobacterial treatment was significantly more likely to achieve culture conversion and successful treatment for Mx-PD patients. Mortality among Mx-PD patients was numerically, but not statistically higher, possibly explained by increased comorbidity burden.

View all citing articles on Scopus

Drs. Koh and J.H. Lee contributed equally to this work.

The authors have no financial or other potential conflicts of interest to disclose.

This work was supported by the Samsung Biomedical Research Institute grant SBRI C-A6–402-1.

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Chest

ORIGINAL RESEARCHMYCOBACTERIAL DISEASEPrevalence of Gastroesophageal Reflux Disease in Patients With Nontuberculous Mycobacterial Lung Disease

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Discussion

Chest

Infect Dis Clin North Am

Tuberculosis (Edinb)

Chest

Chest

Chest

Am J Gastroenterol

Chest

Chest

Clin Chest Med

Chest

Gastroenterology

Clin Gastroenterol Hepatol

Diagnosis and treatment of disease caused by nontuberculous mycobacteria

Am J Respir Crit Care Med

Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases: a Korean perspective

J Korean Med Sci

Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings

Radiology

Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in nontuberculous mycobacterial pulmonary infection

Radiology

Thin-section CT findings of nontuberculous mycobacterial pulmonary diseases: comparison betweenMycobacterium avium-intracellularecomplex andMycobacterium abscessusinfection

J Korean Med Sci

ORIGINAL RESEARCH
MYCOBACTERIAL DISEASE
Prevalence of Gastroesophageal Reflux Disease in Patients With Nontuberculous Mycobacterial Lung Disease