| Abstract | Cilj: Kod bolesnika s gastroezofagealnom refluksnom bolesti (GERB) procijeniti: 1) postoji li
uzročno-posljedična povezanost GERB-a i promjena difuzijskoga kapaciteta pluća za
ugljični monoksid (DLCO), 2) postoji li povezanost promjena DLCO i endoskopskoga nalaza u
jednjaku, 3) veličinu intrapulmonalnoga šanta (QS/QT ) pluća i usporediti je s veličinom
DLCO.
Ispitanici i metode: U presječno istraživanje uključeno je 118 ispitanika – 75 bolesnika,
upućenih na gastroduodenoskopiju, zbog simptoma GERB-a (žgaravice, regurgitacije, bolova
i žarenja u epigastriju), i 43 zdrava ispitanika bez simptoma GERB-a sličnih
antropometrijskih značajki. Na temelju endoskopskoga nalaza, bolesnici su svrstani u skupinu
s erozivnom refluksnom bolesti (ERB) i skupinu s neerozivnom refluksnom bolesti (NERB).
Spirometrijski testovi, difuzijski kapacitet pluća za ugljični monoksid, mjeren metodom
jednoga udaha (DLCO) i intrapulmonalni šant (QS/QT), učinjen metodom udisanja 100%
kisika, izmjereni su kod svih ispitanika.
Rezultati: Statistički znatna razlika između ispitanika s GERB-om i kontrolne skupine
zdravih ispitanika uočena je za sljedeće spirometrijske pokazatelje: FEV1/FVC (p<0,001),
PEF (p<0,001) i FEF75 (p=0,006). Nije bilo statistički znatne razlike za FVC (p=0,512),
FEV1 (p=0,133), FEF50 (p=0,759) i FEF25 (p>0,950). Prosječna vrijednost DLCO GERB
skupine izražena kao % predviđene vrijednosti bila je mnogo niža nego u kontrolnoj skupini
(p=0,019). Još osjetnija statistička razlika između tih skupina pokazala se za prosječne
vrijednosti DLCO/VA (p<0,001). Prosječna vrijednost QS/QT bila je mnogo veća u GERB,
nego u kontrolnoj skupini (p<0,001). Utvrđena je negativna linearna povezanost između
vrijednosti DLCO i QS/QT (r=-0,659; p<0,001), te između DLCO/VA i QS/QT (r=-0,779;
p<0,001). Vrijednosti testova plućne funkcije ERB i NERB skupine nisu se osjetno
razlikovale.
Zaključak: Rezultati našega istraživanja upućuju na uzročno-posljedičnu povezanost između
smanjenja difuzije plinova u plućima i GERB-a. Mikroaspiracija kiseloga želučanog
refluksata u pluća vodi k oštećenju surfaktanta, kolapsu alveola, razvoju mikroatelektaza,
povećanju intrapulmonalnoga šanta, i utječe na smanjenje difuzije plinova. DLCO je osjetljivi
pokazatelj smanjenja difuzije plinova u plućima, a još je osjetljiviji ako ga se izrazi prema
jedinici alveolarnoga volumena (DLCO/VA). Oba su pokazatelja difuzije negativno povezana
s intrapulmonalnim šantom. Promjene uočene u našemu istraživanju bile su podjednako
zastupljene kod bolesnika s erozivnim i neerozivnim oblikom GERB-a. |
| Abstract (english) | Background/Aim: In patients with gastroesophageal reflux disease (GERD) the following
should be assessed: 1) whether there is a causal connection between GERD and changes in
lung diffusion capacity for carbon monoxide (DLCO), 2) the relationship between changes in
DLCO and endoscopic findings in the esophagus, 3) size of intrapulmonary shunt (QS/QT) and
its correlation with the size of DLCO.
Methods: The study enrolled 118 subjects -75 patients who were referred for gastroduodenal
endoscopy because of symptoms of GERD (heartburn, acid regurgitation, dysphagia) and 43
healthy subjects of similar anthropometric characteristics without any symptoms of GERD.
On the basis of endoscopic findings the patients were divided into groups, one with erosive
reflux disease (ERB) and the other with non erosive reflux disease (NERD). Spirometry tests,
pulmonary diffusing capacity for carbon monoxide measured by single breath method (DLCO)
and intrapulmonary shunt (QS/QT) made using 100% oxygen inhalation were measured in all
subjects.
Results: Statistically significant differences between subjects with GERD and the control
group of healthy subjects was observed for the following spirometry parameters: FEV1/FVC
(p<0.001), PEF (p<0.001) and FEF75 (p=0.006). There were no statistically significant
differences in FVC (p=0.512), FEV1 (p=0.133), FEF50 (p=0.759) and FEF25 (p<0.950). The
average value of DLCO GERD group, expressed as a percentage of predicted values, were
significantly lower than in the control group (p=0.019). Even greater statistical significance
between these groups was shown by a mean value of DLCO/VA (p<0.001). The average value
of QS/QT was significantly higher in GERD than in the control group (p<0.001). There was a
negative linear correlation between DLCO and QS/QT (r=-0.659, p<0.001) and between
DLCO/VA and QS/QT (r=-0.779, p<0.001). The values of lung function tests ERB and NERD
groups did not differ significantly.
Conclusions: Our findings indicate a causal connection between damage to the diffusion of
gases in the lungs and GERD. Damage to the diffusion of gases may be caused by
microaspiration of stomach contents to the lungs, with consequent impairment of surfactant,
alveoli collapse, and development of microatelectasis and increase of intrapulmonary shunt.
DLCO is a sensitive indicator of damage to the diffusion of gases in the lungs, and even more
sensitive if it is expressed per unit of alveolar volume (DLCO/VA). Both diffusion parameters
are negatively correlated with the intrapulmonary shunt. The observed changes in our study
were equally represented in patients with erosive and non erosive form of GERD. |
