Delayed gastric emptying does not contribute to worse gastroesophageal reflux and pulmonary function in patients with respiratory disease
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Bradley, Jessica
Olson, Caroline
Alghubari, Ali
Cheah, Ramsah
Shah, Sadia
Lee, Augustine
DeVault, Kenneth
Houghton, Lesley
LTHT Author
LTHT Department
Non Medic
Publication Date
2025-07-10
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Abstract
Background: Gastroesophageal reflux (GER) is common and thought to contribute to disease progression, via its aspiration into the lungs, in patients with respiratory disease. Delayed gastric emptying (DGE) can increase GER in patients with GER disease, but its effect in patients with respiratory disease, and how differing lung structure and mechanics influences this, is unknown.
Aim: To understand these inter-relationships and associations with pulmonary function in patients with end-stage chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF) and non-IPF interstitial lung disease (non-IPF ILD).
Methods Twenty two patients with COPD (aged 34-75yrs), 33 with IPF (45-74yrs), and 19 with non-IPF ILD (37-74yrs), of which 10 had fibrotic non-specific interstitial pneumonia (NSIP), 5 chronic hypersensitivity pneumonitis (CHP) and 4 sarcoidosis, referred for gastric emptying studies (DGE, defined as >10% remaining at 4hr), esophageal high resolution impedance manometry (HRIM), and 24hr pH-impedance (MII-pH), as part of their work-up for lung transplantation at Mayo Clinic, Florida, were evaluated.
Results: Gastric emptying was delayed in a total of 20(27%) patients; 5(23%) with COPD, 8(24%) with IPF and 7(37%) with non-IPF ILD. Notably all 7 non-IPF ILD patients with DGE had NSIP (i.e. 70% of NSIP patients), which was higher than the proportion of COPD (p=0.057) and IPF (p=0.019) patients with DGE. There were no differences in oesophageal reflux exposure between patients with DGE and normal gastric emptying (NGE) for any of the 3 cohorts. Likewise, there were no differences in pulmonary function.
Conclusion: DGE in respiratory disease, irrespective of whether patients have COPD, IPF or non-IPF ILD, does not increase GER or worsen the severity of respiratory disease. Of note, 70% of non-IPF ILD patients with NSIP have DGE. Our data have important clinical implications as to whether patients with NGE should be prioritized over those with DGE for lung transplantation.