In Current Respiratory Care Reports, Takahashi and Noth reviewed the data on the relationship between gastroesophageal reflux (GER) and IPF toward a better understanding of treatment protocols that may benefit patients.*
GER is a common ailment, specifically defined as regurgitation of stomach contents into the esophagus. Previous research has shown that many factors are associated with GER—lung disease being one. For example, it has been hypothesized that patients with COPD have different pressures in their lungs and chest which could affect pressure on the abdomen and stomach. A delicate pressure gradient is required to avoid reflux, thus any pressure change could lead to GER. Patients with hiatal hernias also can have differences in pressure leading to GER.
Reflux is especially harmful to lung disease patients if microaspiration occurs, which involves not only reflux of stomach contents up the esophagus and into the throat, but also inhalation of those contents into the airway. At times, aspiration doesn’t cause any symptoms; at other times, it can cause coughing, wheezing and hoarseness. Moreover, it is believed that aspiration leads to enough lung tissue damage to cause disease. Besides COPD, GER is associated with lung diseases such as asthma and scleroderma.
The authors state that over the last twenty years, research has been published investigating the relationship between IPF and GER. IPF patients often have higher GER rates than normal and patients with other lung diseases, even if asymptomatic. The researchers suggest that providers use various tests on IPF patients to diagnose GER since symptoms expression may be lower than other populations.
There is some evidence that treating GER in IPF patients can halt disease progression and prolong survival. Patients with more advanced disease who are awaiting lung transplantation may especially benefit from Nissen fundoplication (a laparoscopic procedure to relieve GER and hiatal hernia) or proton pump inhibitors (a class of drugs that reduce stomach acid through enzymatic inhibition).
While IPF treatment options are limited, Takahashi and Noth suggest that treating GER may positively impact many clinical variables for these patients.
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*Takahashi, S.M. & Noth, I. (2013). GERD and idiopathic pulmonary fibrosis: Cause or effect. Current Respiratory Care Reports, 2, 260.