High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis

Abstract

The aim of this prospective study was to determine the prevalence and characteristics of acid gastro-oesophageal reflux (GER) in patients with idiopathic pulmonary fibrosis (IPF).Sixty-five consecutive patients with well-defined IPF were subjected to 24-h pH monitoring and oesophageal manometry. A total of 133 consecutive patients with intractable asthma and symptoms of GER were used as comparisons.The prevalence of abnormal acid GER in IPF patients was 87%, with 76% and 63% demonstrating abnormal distal and proximal oesophageal acid exposures, respectively. Abnormal acid GER was significantly more common in IPF patients than asthma patients. Only 47% of IPF patients experienced classic GER symptoms. Despite treatment with standard doses of proton pump inhibitors (PPIs), 12 out of 19 patients receiving PPIs during the 24-h pH monitoring had abnormal oesophageal acid exposures by pH probe. There was no correlation between IPF severity and acid GER severity.In conclusion, abnormal acid gastro-oesophageal reflux is highly prevalent, but often clinically occult in patients with idiopathic pulmonary fibrosis. Standard doses of proton pump inhibitors may not suppress the acid gastro-oesophageal reflux in this population. Therefore, further studies are needed to determine if acid abnormal gastro-oesophageal reflux represents an important risk factor for idiopathic pulmonary fibrosis development or progression, and if optimal suppression of acid gastro-oesophageal reflux slows the progression of idiopathic pulmonary fibrosis and/or decreases episodic exacerbations of idiopathic pulmonary fibrosis.

The Intersection of GERD, Aspiration, and Lung Transplantation

“…2 Similarly, before transplantation, the presence of GERDinduced aspiration has been linked to pulmonary failure, particularly in patients with IPF. 3 Therefore, GERD is thought to play a significant role in the decline in lung function before transplantation and the rejection after lung transplantation, likely by causing aspiration-mediated lung injury.…”

“…The following topics were discussed: (1) pathophysiology of GERD-induced pulmonary symptoms, (2) GERD evaluation before and after lung transplantation, (3) outcome of lung transplantation for IPF and scleroderma, and (4) role of laparoscopic fundoplication before or after lung transplantation.…”

Pathophysiological Studies Are Mandatory to Understand the Benefit of Proton Pump Inhibitors in Patients with Idiopathic Pulmonary Fibrosis

“…This is particularly relevant since it has been shown in previous series that a large number of IPF patients lack of GERD symptoms despite objective evidence of GERD at endoscopy or reflux monitoring. [2][3][4] Indeed, in IPF patients a phenomenon so called "silent reflux" has been described and the consequent microaspiration into the lungs has been mainly implicated in the pathogenesis of this condition. 5 In contrast with the paper of Lee et al, 1 many previous studies have reported a higher prevalence of GERD in patients with IPF, [2][3][4] and this important relationship has been sustained by pathophysiological investigations which allowed to detect objectively the presence of an abnormal reflux.…”

“…[2][3][4] Indeed, in IPF patients a phenomenon so called "silent reflux" has been described and the consequent microaspiration into the lungs has been mainly implicated in the pathogenesis of this condition. 5 In contrast with the paper of Lee et al, 1 many previous studies have reported a higher prevalence of GERD in patients with IPF, [2][3][4] and this important relationship has been sustained by pathophysiological investigations which allowed to detect objectively the presence of an abnormal reflux. For instance, Lee et al 1 did not mention a study in IPF individuals performed with 24-hour impedance pH monitoring, which is nowadays considered to be the best test for measuring gastroesophageal reflux, also in case of atypical manifestations.…”

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

“…First, there is wide presentation of GER in IPF patients [4]. Second, age, smoking and male gender playing a role as a shearing risk factors in both IPF and GER [5].…”