الفهرس 
Interstitial Lung DiseasesOnly 14 pages are availabe for public view
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Abstract
ILD is an umbrella of a large group of respiratory disorders including IPF, SS, interstitial pneumonia, nonspecific interstitial pneumonitis, HP, sarcoidosis and asbestosis
ILD is characterized by cellular and extracellular infiltrates distal to the terminal bronchioles or acini causing pulmonary scarring and irreversible lung damage. Symptoms of ILD include dyspnea, nonproductive cough, fatigue and weight loss and decreased exercise tolerance
GERD is a very common digestive disorder worldwide with an estimated prevalence of 18.1–27.8% in North America. Approximately half of all adults will report reflux symptoms at some time. According to the Montreal definition, GERD is a condition of troublesome symptoms and complications that result from the reflux of stomach contents into the esophagus.
Diagnosis of GERD is typically based on classic symptoms and response to acid suppression after an empiric trial. GERD is an important health concern as it is associated with decreased quality of life and significant morbidity. Successful treatment of GERD symptoms has been associated with significant improvement in quality of life, including decreased physical pain, increased vitality, physical and social function, and emotional well-being. While GERD medications are not particularly expensive, the cost of treating GERD patients has been deemed 2-fold more costly than comparable individuals without GERD.
GERD develops from reflux of the gastric contents causing troublesome symptoms and/or complications. Classical manifestations of GERD are heartburn and regurgitation “typical symptoms” and a series of extra-esophageal symptoms “atypical symptoms” as chronic cough, laryngitis, asthma, pharyngitis, sinusitis, recurrent otitis media and IPF.
GERD causal role in ILD has been only speculated and sub-types of ILD that have been associated with GERD with varying degrees of evidence are SS, IPF, obliterative bronchiolitis, and alveolar proteinosis. Moreover, GERD in ILD patients was frequently asymptomatic and typical symptoms often didn’t allow making a certain diagnosis so, all ILD patients should be screened for GERD as prominent etiological factor of ILD.
Upper gastrointestinal endoscope is a diagnostic endoscopic procedure used to visualize the oropharynx, esophagus, stomach, and proximal duodenum. It is one of the most common procedures for gastroenterologists.
Our study aimed to assess the role of screening of patient proved to have GERD by upper gastrointestinal endoscope for early detection of ILD.
Our study was conducted at chest diseases department of Ain Shams university hospitals and conducted on 90 randomly selected patients diagnosed with GERD by upper gastrointestinal endoscopy for one year.
The main results of the study revealed that:
The basic demographic data demonstrate that the male patients 59 (65.6%) are more than the female patients 31 (34.4%). Among all patients the most common medical comorbidities were hypertension 34 (37.8%) and diabetes 14 (15.6%). The disease characteristics of enrolled patients is as regard GERD symptoms, the most common presented symptoms was Backwash (Regurgitation) of food or sour liquid 90(100%) and the least common were difficulty of swallowing (dysphagia) 65(72.2%). Regarding dietary habits, the majority of patients were those who having coffee 86(95.6%) and spicy food 87(96.7%). On the other hand, GERD-Q score ranging from 9-15 which is a high value that reflects the GERD likelihood which is ranging 79-89. The chest symptoms and signs is 72 patients (80%) complained of at least one chest symptom. On the other hand, only 16 patients (17.8%) demonstrated at least one positive sign on chest examination. The most common symptom was chest pain, reported by 71 patients (78.9%).The results of the 6-minute walking test is The mean distance walked was 543 ± 93 m, ranging from 453 to 652 m. At the end of the test, the mean HR increased from 91.7 ± 4.7 to 109.7 ± 6.4 bpm. Dyspnea was reported in 13 patients (14.4%), fatigue was reported in 16 (17.8%), and SPO2 declined from 98.2 ± 1.1% to 96.2 ± 1.7%.The findings of chest HRCT for enrolled patients is 15 patients (16.7%) showed positive CT findings suggestive of ILD, whereas 75 patients (83.3%) had normal CT scan. The most common CT finding was atelectasis reported in nine patients (10%).A statistically significant positive correlation between age and fibrosis and reticular infiltration. A statistically significant correlation between female gender and reticular infiltration. No statistically significant correlation between CT findings and each of chest symptoms and GERD symptoms. A statistically significant correlation between spices and consolidation. A statistically significant correlation between the presence of hiatal hernia and atelectasis and reticular infiltration. A statistically significant correlation between the age and cough, dyspnoea, and wheezes.
Conclusion
CT chest screen of patients diagnosed as GERD by upper gastrointestinal endoscopy is of a favorable role in early detection of ILD to help early management and treatment of them. In patients diagnosed as GERD by upper gastrointestinal endoscopy we revealed that:
- Reticular infiltration is more prevalent in female gender
- Reticular infiltration and fibrosis increases with older age
- Reticular infiltration and atelectasis increases in patients have hiatus hernia
- Cough, dyspnea and wheezes increases in older age.
Recommendations
Further studies with larger sample size with longer follow-up period are needed to confirm the current results.
We recommended that the patient have GERD by upper gastrointestinal endoscopy is needed to undergo CT scan especially female gender, old age and those have hiatal hernia.