Divergent Management of the Foregut Between Pulmonologists and Gastroenterologists in Advanced Cystic Fibrosis Lung...

Advanced cystic fibrosis lung disease (ACFLD) remains a major cause of morbidity, particularly in individuals requiring lung transplantation. Gastrointestinal-related aspiration (GRASP), including reflux and motility disorders, may contribute to adverse respiratory outcomes, yet diagnostic and management strategies vary across specialties.

To evaluate practice patterns in foregut testing and pharmacologic management of GRASP among pulmonologists and gastroenterologists caring for individuals with ACFLD, with and without transplantation.

A cross-sectional survey of clinicians at cystic fibrosis centers was distributed via a national listserv. Respondents involved in ACFLD care were included. Descriptive statistics were generated, and comparisons by specialty were performed using Fisher's exact and Mann-Whitney U tests (α = 0.05).

Forty-five complete responses were analyzed (82% pulmonologists, 18% gastroenterologists). Eighty percent reported access to gastrointestinal motility testing. Overall use of reflux, motility, and gastric emptying testing was similar between specialties; however, modality selection differed. Gastroenterologists favored pH multichannel intraluminal impedance (75%) and BRAVO capsule testing (25%), while pulmonologists demonstrated heterogeneous practices and frequently deferred testing (37.8%). High-resolution manometry was universally preferred by gastroenterologists but variably used by pulmonologists. Acid suppression was widely utilized, with proton pump inhibitors most common, though pulmonologists showed greater variability, particularly post-transplant.

Substantial variability exists in GRASP evaluation and management in ACFLD. Standardized, multidisciplinary approaches may improve diagnostic consistency and optimize outcomes, especially in the transplant population.