Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease
© 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd..
BACKGROUND: Gastroesophageal reflux (GER) is known to be associated with chronic lung diseases. The driving force of GER is the transdiaphragmatic pressure (Pdi) generated mainly by costal and crural diaphragm contraction. The latter also enhances the esophagogastric junction (EGJ) pressure to guard against GER.
METHODS: The relationship between Pdi and EGJ pressure was determined using high resolution esophageal manometry in patients with interstitial lung disease (ILD, n = 26), obstructive lung disease (OLD, n- = 24), and healthy subjects (n = 20).
KEY RESULTS: The patient groups did not differ with respect to age, gender, BMI, and pulmonary rehabilitation history. Patients with ILD had significantly higher Pdi but lower EGJ pressures as compared to controls and OLD patients (p < 0.001). In control subjects, the increase in EGJ pressure at all-time points during inspiration was greater than Pdi. In contrast, the EGJ pressure during inspiration was less than Pdi in 14 patients with ILD and 7 patients with OLD. The drop in EGJ pressure was usually seen after the peak Pdi in ILD group (p < 0.0001) and before the peak Pdi in OLD group, (p = 0.08). Nine patients in the ILD group had sliding hiatus hernia, compared to none in control subjects (p = 0.003) and two patients in the OLD, (p = 0.04).
CONCLUSIONS AND INFERENCES: A higher Pdi and low EGJ pressure, and dissociation between Pdi and EGJ pressure temporal relationship suggests selective dysfunction of the crural diaphragm in patients with chronic lung diseases and may explain the higher prevalence of GERD in ILD as seen in previous studies.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Neurogastroenterology and motility - 36(2024), 1 vom: 20. Jan., Seite e14699 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Joshua, Jisha [VerfasserIn] |
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| Links: |
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| Themen: |
Crural diaphragm |
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| Anmerkungen: |
Date Completed 28.12.2023 Date Revised 07.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/nmo.14699 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363742409 |
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| 500 | |a Date Revised 07.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Gastroesophageal reflux (GER) is known to be associated with chronic lung diseases. The driving force of GER is the transdiaphragmatic pressure (Pdi) generated mainly by costal and crural diaphragm contraction. The latter also enhances the esophagogastric junction (EGJ) pressure to guard against GER | ||
| 520 | |a METHODS: The relationship between Pdi and EGJ pressure was determined using high resolution esophageal manometry in patients with interstitial lung disease (ILD, n = 26), obstructive lung disease (OLD, n- = 24), and healthy subjects (n = 20) | ||
| 520 | |a KEY RESULTS: The patient groups did not differ with respect to age, gender, BMI, and pulmonary rehabilitation history. Patients with ILD had significantly higher Pdi but lower EGJ pressures as compared to controls and OLD patients (p < 0.001). In control subjects, the increase in EGJ pressure at all-time points during inspiration was greater than Pdi. In contrast, the EGJ pressure during inspiration was less than Pdi in 14 patients with ILD and 7 patients with OLD. The drop in EGJ pressure was usually seen after the peak Pdi in ILD group (p < 0.0001) and before the peak Pdi in OLD group, (p = 0.08). Nine patients in the ILD group had sliding hiatus hernia, compared to none in control subjects (p = 0.003) and two patients in the OLD, (p = 0.04) | ||
| 520 | |a CONCLUSIONS AND INFERENCES: A higher Pdi and low EGJ pressure, and dissociation between Pdi and EGJ pressure temporal relationship suggests selective dysfunction of the crural diaphragm in patients with chronic lung diseases and may explain the higher prevalence of GERD in ILD as seen in previous studies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a crural diaphragm | |
| 650 | 4 | |a esophagogastric junction | |
| 650 | 4 | |a gastroesophageal reflux | |
| 650 | 4 | |a hiatus hernia | |
| 650 | 4 | |a lower esophageal sphincter | |
| 650 | 4 | |a transdiaphragmatic pressure gradient | |
| 700 | 1 | |a Pathak, Chetna |e verfasserin |4 aut | |
| 700 | 1 | |a Zifan, Ali |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Ruohui |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Atul |e verfasserin |4 aut | |
| 700 | 1 | |a Mittal, Ravinder K |e verfasserin |4 aut | |
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