PT  - JOURNAL ARTICLE
AU  - M P Sweet
AU  - M G Patti
AU  - C Hoopes
AU  - S R Hays
AU  - J A Golden
TI  - Gastro-oesophageal reflux and aspiration in patients with advanced lung disease
AID  - 10.1136/thx.2007.082719
DP  - 2009 Feb 01
TA  - Thorax
PG  - 167--173
VI  - 64
IP  - 2
4099  - http://thorax.bmj.com/content/64/2/167.short
4100  - http://thorax.bmj.com/content/64/2/167.full
SO  - Thorax2009 Feb 01; 64
AB  - Numerous small observational studies have shown that gastro-oesophageal reflux is prevalent among patients with advanced lung disease. The fundamental concern is that reflux is a risk factor for recurrent microaspiration, which may cause lung injury. For example, in lung transplant patients, a molecular marker of aspiration was a risk factor for the bronchiolitis obliterans syndrome in one study. To date, however, there are no large prospective studies measuring the impact of aspiration on clinical outcomes. The major obstacle limiting the study of reflux and aspiration in patients with advanced lung disease is the absence of a reliable diagnostic tool. Proximal oesophageal acid detection by pH monitoring is the only widely available measure of aspiration risk. Impedance monitoring may be a superior measure of aspiration risk as it measures both acid and non-acid reflux episodes. Molecular markers of aspiration, such as pepsin or bile salts in the bronchoalveolar lavage or exhaled breath condensate, may be the optimal diagnostic tests, but they are not currently available outside the research setting. Larger observational studies are needed to determine the following: (1) the clinical significance of aspiration in patients with advanced lung disease and in patients who have had lung transplantation and (2) the diagnostic test that best predicts adverse outcomes.