OH MY GERD! ILD AND RECURRENT ASPIRATION PNEUMONIA IN THE SETTING OF SEVERE GERD

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Heartburn is notorious for causing a chronic cough that produces negative pulmonary workup. In severe gastroesophageal reflux disease (GERD) the stakes are higher, with complications aspiration pneumonia and chemical pneumonitis leading to interstitial lung (ILD). We present case reversed clinical picture - clinically significant findings suggesting GERD without being able confirm aspiration. CASE PRESENTATION: A 61 year old gentleman refractory restrictive requiring home oxygen was admitted hospital dyspnea hypoxia. The patient hypoxic on presentation, saturation in 60s 2L, only improving 85% non-invasive ventilation, thus intubation. x-ray revealed bibasilar hazy infiltrates, right greater than left. Tracheal aspirate culture grew E. coli, diagnosing pneumonia, which then treated appropriately. This patient's ninth episode of last twelve months, several these hospitalization. Past medical history included laparoscopic sleeve gastrectomy peptic ulcer ten years ago symptoms persisting failing proton pump inhibitor therapy H2 therapy. On recent hospitalization his recurrent pneumonias, workup multiple speech evaluations modified barium swallow concerning but not confirming Esophagogastroduodenoscopy discovered four centimeter hiatal hernia Barrett's esophagus. pH monitoring elevated acid exposure time (29.5% vs normal <4.5%). Patient referred surgery further treatment options. He cautioned problems would resolve until controlled. DISCUSSION: exemplifies severe, uncontrolled GERD. While could reveal aspiration, it reasonable conclude nevertheless aspirating frequently, particularly at night. These were likely exacerbated by sedating medications he taking, like quetiapine. Additionally, while uncommon after gastric modification, there few cases described literature severely enough cause pneumonia. small together sleeve, both innocent their own, caused synergy this experienced. Without surgical intervention, unlikely will improve. CONCLUSIONS: patients should be high differential, even absence evidence REFERENCE #1: Taylor JK, Fleming GB, Singanayagam A, Hill AT, Chalmers JD. Risk factors community-acquired pneumonia: analysis hospitalized UK cohort. Am J Med. 2013 Nov;126(11):995-1001. DISCLOSURES: No relevant relationships Samapon Duangkham, source=Web Response Ricardo Franco, Added 12/03/2020 Ebtesam Islam, Response, value=Consulting fee Removed 04/30/2021 Haitem Mezughi, Alexandra Wichmann,