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Sarcoidosis and gastroesophageal reflux

Publication at Faculty of Medicine in Pilsen |
2018

Abstract

Sarcoidosis is known as a multisystem granulomatous disease of unknown etiology that, accor-ding to the literature, may be complicated by gastroesophageal reflux. The study included patients with confirmed sarcoidosis undergoing detailed gastroen-terological examination after pepsin was detected in their respiratory secretions.

The assessed parameters were stages of sarcoidosis, severe comorbidities, clinical picture and 24-hour esophageal impedance-pH monitoring results, with respect to proton pump inhibitor (PPI) therapy and pepsin concentration in respiratory secretions. The sample comprised 25 pts, 18 females and 7 males, with a median age of 59 years (range, 32-78 years).

Most frequently, stage II was diagnosed (17 pts), followed by stage I-II in 3 pts and stage II-III in 3 pts. The most frequent comorbidities were bronchial asthma (4 pts), COPD (2 pts) and diabetes mellitus (2 pts).

Pep test was positive in 19 pts and slightly positive in 6 pts. Acidic reflux was detected in 17 pts and weakly acidic reflux in 2 pts; no abnormal reflux was found in 6 pts.

Among pts not treated with PPIs, 15/18 had acidic reflux. Esophageal impedance showed an increased frequency of proximal reflux in 21/25 pts.

The most common clinical manife-stations in pts with reflux confirmed by pH monitoring were cough, pyrosis and regurgitation, chest tightness and globus sensation. Among patients without reflux confirmed by pH monitoring (6 pts), 50 % had cough, 33 % had pyrosis and regurgitation and 17 % had globus sensation.

The results showed a high rate of GERD in sarcoidosis pts, in particular acidic esophageal re-flux and frequent proximal reflux. Therefore, it would be rational to examine sarcoidosis pts for the presence of GERD; however, their clinical problems cannot be considered as valid.

Gastroesophageal reflux disease may also be associated with some comorbidities in sarcoidosis pts and may negatively influence the extent of paren-chymal lung involvement.