Gastro-oesophageal reflux and idiopathic pulmonary fibrosis: the heart burn in patients with IPF can no longer be silent

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease of complex cause affecting an elderly population where multimorbidity is frequent. There is an increasing understanding of the distinct comorbidities over-represented in patients with IPF and associated with a clinically important impact on symptoms and outcomes [1–4]. More than 40 years ago, Mays et al. [5] were the first to describe a potential association between gastro-oesophageal reflux (GOR) and IPF. Since then multiple reports have established that gastro-oesophageal reflux disease (GORD) is one of the most prevalent comorbid conditions in IPF. Based on the increased prevalence, it has been hypothesised that GOR-associated microaspirations may have a pathogenic role in IPF. This stimulated further research, including in animal models, which suggested that aspiration of acid refluxate causes the parenchymal damage associated with pneumonitis and increased epithelial permeability with the consequence of stimulated fibrotic proliferation and perhaps of acute exacerbations (summarised in [6]). Therefore, an early dream was that supressing microaspiration may alter the course of IPF, namely by allowing greater symptom management, disease stabilisation and perhaps improved survival [7].
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interstitial and orphan lung disease Editorials Source Type: research