Assessment of gastroesophageal reflux disease in chronic obstructive pulmonary disease: Is measuring cardioesophageal angle on multidetector computed tomography images useful?

We aimed to investigate whether there were any differences between patients with chronic obstructive pulmonary disease (COPD) and controls according to their cardioesophageal angles (COA) by Computed tomography (CT) and also the relationship between the degrees of COA and pulmonary function values in COPD patients. Degrees of COA were measured on curved oblique coronal CT images of 198 COPD patients with gastroesophageal reflux (GER) and 298 control subjects. A comparative analysis of COA values in two groups was performed and possible correlations between degrees of COA and pulmonary function parameters were evaluated. COA values were significantly higher in COPD patients compared to controls (p< 0.001). The degrees of COA was negatively correlated with FVC and FEV1 values (% and L) in COPD patients (p<0.001, r=-0.579; p<0.001, r=-0.64 and p<0.001, r=-0.65; p<0.001, r=-0.615, respectively). A positive correlation between age and COA was found in all the study population (p=0.002; r=0.134). A negative correlation between COA and BMI was found in COPD patients (p= 0.037, r=-0.149). In conclusion, COPD patients have significantly increased COA value which is a predisposing factor for GER. Also, the association between obtuse COA and decreased levels of pulmonary function parameters in COPD patients may indicate reflux-induced bronchoconstriction and should be considered in COPD management as a non invasive indicator of reflux.