Should All Patients With IPF Be Treated for GER?

Background

A number of studies have shown a strong association between gastroesophageal reflux (GER), through its presumed association with microaspiration, and IPF.1-3 Additionally, studies utilizing esophageal 24-hour pH monitoring indicate that GER is very common among patients with IPF, with a prevalence of 67% to 88% for distal esophageal reflux and 30% to 71% for proximal esophageal reflux,3,4 even in the absence of classical reflux symptoms.1,4

The question that remains is, “Can the use of medical and/or surgical therapies for GER improve survival time in patients with IPF?” Lee, Ryu, Elicker, Lydell, et al attempted to answer this question.5

What They Did

The authors identified patients with IPF retrospectively from 2 longitudinal cohorts of patients with interstitial lung disease seen at the University of California, San Francisco (n=84) and the Mayo Clinic (Rochester, MN) (n=120), from April 2001 until July 2008.5 Data from these cohorts were collected prospectively and systematically and included symptoms, comorbidities, and medication use via standardized questionnaires and physician review.

What They Found

Almost one-half of patients had a history of GER and about one-third had GER symptoms. Five percent had undergone surgical intervention (Nissen fundoplication) for the treatment of GER. Unsurprisingly, almost 50% reported use of GER medications.5 On unadjusted regression analysis, all of these GER variables were significantly associated with longer survival time. After adjustment, treatment with GER medications was an independent predictor of longer survival time. Of interest, GER medication use was also associated with a lower radiologic fibrosis score. The findings did not differ by center.

What It Means

Although the results of this study need validation with a prospective longitudinal cohort study, the findings support a potentially important role of GER and chronic microaspiration in the pathobiology of IPF.5 Further, the study suggests that GER treatment is associated with longer survival time and less radiologic fibrosis.

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/21700909



References

  1. Raghu G, Freudenberger TD, Yang S, et al. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J. 2006;27:136-142.
  2. el-Serag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology. 1997;113:755-760.
  3. Tobin RW, Pope CE, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158:1804-1808.
  4. Lee JS, Collard HR, Raghu G, et al. Does chronic microaspiration cause idiopathic pulmonary fibrosis? Am J Med. 2010;123:304-311.
  5. Lee JS, Ryu JH, Elicker BM, et al. Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmnary fibrosis. Am J Respir Crit Care Med. 2011;184:1390-1394.