Prevalência da doença do refluxo gastroesofágico em pacientes com fibrose pulmonar idiopática

Bandeira, Cristiane Dupont; Rubin, Adalberto Sperb; Cardoso, Paulo Francisco Guerreiro; Moreira, José da Silva; Machado, Mirna da Mota

doi:10.1590/s1806-37132009001200004

Cited by 38 publications

(21 citation statements)

References 22 publications

(33 reference statements)

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“…It has been assumed that the presumed benefit of PPIs in measures of lung function in IPF is due to a reduction in gastric acidity that would reduce potential lung injury due to microaspiration. Although GER commonly accompanies IPF [ 10 , 76 , 85 ]; and it is believed that anti-reflux strategies may benefit IPF [ 70 ], several reports have indicated the lack of direct and complete association between the progression of GER and IPF [ 10 , 77 , 80 , 86 – 88 ]. Paradoxically, some IPF patients who undergo fundoplication therapy have been initially placed on PPIs and failed to suppress symptoms of reflux such as heartburn and regurgitation despite the PPIs; making them eligible for the surgical procedure (see the question and answer section of ref [ 70 ]).…”

Section: Discussionmentioning

confidence: 99%

Pleiotropic effect of the proton pump inhibitor esomeprazole leading to suppression of lung inflammation and fibrosis

Ghebremariam¹,

Cooke²,

Gerhart³

et al. 2015

J Transl Med

112

129

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BackgroundThe beneficial outcome associated with the use of proton pump inhibitors (PPIs) in idiopathic pulmonary fibrosis (IPF) has been reported in retrospective studies. To date, no prospective study has been conducted to confirm these outcomes. In addition, the potential mechanism by which PPIs improve measures of lung function and/or transplant-free survival in IPF has not been elucidated.MethodsHere, we used biochemical, cell biological and preclinical studies to evaluate regulation of markers associated with inflammation and fibrosis. In our in vitro studies, we exposed primary lung fibroblasts, epithelial and endothelial cells to ionizing radiation or bleomycin; stimuli typically used to induce inflammation and fibrosis. In addition, we cultured lung fibroblasts from IPF patients and studied the effect of esomeprazole on collagen release. Our preclinical study tested efficacy of esomeprazole in a rat model of bleomycin-induced lung injury. Furthermore, we performed retrospective analysis of interstitial lung disease (ILD) databases to examine the effect of PPIs on transplant-free survival.ResultsThe cell culture studies revealed that esomeprazole controls inflammation by suppressing the expression of pro-inflammatory molecules including vascular cell adhesion molecule-1, inducible nitric oxide synthase, tumor necrosis factor-alpha (TNF-α) and interleukins (IL-1β and IL-6). The antioxidant effect is associated with strong induction of the stress-inducible cytoprotective protein heme oxygenase-1 (HO1) and the antifibrotic effect is associated with potent inhibition of fibroblast proliferation as well as downregulation of profibrotic proteins including receptors for transforming growth factor β (TGFβ), fibronectin and matrix metalloproteinases (MMPs). Furthermore, esomeprazole showed robust effect in mitigating the inflammatory and fibrotic responses in a murine model of acute lung injury. Finally, retrospective analysis of two ILD databases was performed to assess the effect of PPIs on transplant-free survival in IPF patients. Intriguingly, this data demonstrated that IPF patients on PPIs had prolonged survival over controls (median survival of 3.4 vs 2 years).ConclusionsOverall, these data indicate the possibility that PPIs may have protective function in IPF by directly modulating the disease process and suggest that they may have other clinical utility in the treatment of extra-intestinal diseases characterized by inflammatory and/or fibrotic phases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0614-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Pleiotropic effect of the proton pump inhibitor esomeprazole leading to suppression of lung inflammation and fibrosis

Ghebremariam¹,

Cooke²,

Gerhart³

et al. 2015

J Transl Med

112

129

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“…However, these findings have been controversial, because other groups have found no such difference in the rates of gastroesophageal pathologic features. Bandeira et al [40], in their prospective study of 28 patients with IPF, showed no significant differences with controls regarding the demographic characteristics, pulmonary function, clinical presentation, or manometric findings. Our study was in agreement with these findings with regard to showing no differences in the manometric, barium swallow, or gastric emptying study findings in patients with IPF compared with those with other etiologies of ESLD.…”

Section: Discussionmentioning

confidence: 99%

Pepsin concentrations are elevated in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis after lung transplantation

Davis¹,

Mendez²,

Flint³

et al. 2013

Journal of Surgical Research

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Background Aspiration of gastroesophageal refluxate has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF) and the progression of bronchiolitis obliterans syndrome after lung transplantation. The goals of the present study were to identify lung transplant patients at the greatest risk of aspiration and to investigate the causative factors. Materials and methods From September 2009 to November 2011, 252 bronchoalveolar lavage fluid (BALF) samples were collected from 100 lung transplant patients. The BALF pepsin concentrations and the results of transbronchial biopsy, esophageal function testing, barium swallow, and gastric emptying scan were compared among those with the most common end-stage lung diseases requiring lung transplantation: IPF, chronic obstructive pulmonary disease, cystic fibrosis, and α1-antitrypsin deficiency. Results Patients with IPF had higher BALF pepsin concentrations and a greater frequency of acute rejection than those with α1-antitrypsin deficiency, cystic fibrosis, or chronic obstructive pulmonary disease (P = 0.037). Moreover, the BALF pepsin concentrations correlated negatively with a lower esophageal sphincter pressure and distal esophageal amplitude; negatively with distal esophageal amplitude and positively with total esophageal acid time, longest reflux episode, and DeMeester score in those with chronic obstructive pulmonary disease; and negatively with the upright acid clearance time in those with IPF. Conclusions Our results suggest that patients with IPF after lung transplantation are at increased risk of aspiration and a greater frequency of acute rejection episodes, and that the risk factors for aspiration might be different among those with the most common end-stage lung diseases who have undergone lung transplantation. These results support the role of evaluating the BALF for markers of aspiration in assessing lung transplant patients as candidates for antireflux surgery.

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“…The association between nutritional status measurements and pulmonary function in children and adolescents with cystic fibrosis was analyzed by Chavez et al49 Bandeira et al demonstrated the prevalence of gastroesophageal reflux disease in patients with idiopathic pulmonary fibrosis 50. Costa et al described the role of inflammatory cells and their mediators in COPD pathogenesis 51.…”

Section: Methodsmentioning

confidence: 99%

A review of cardiopulmonary research in Brazilian medical journals: clinical, surgical and epidemiological data

Serrano

Silva

2010

Clinics

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Research in the field of cardiopulmonary disease in Brazil has been very active in recent decades. The combination of PUBMED, SCieLO, open access and online searching has provided a significant increase in the visibility of Brazilian journals. This newly acquired international visibility has in turn resulted in the appearance of more original research reports in the Brazilian scientific press. This review is intended to highlight part of this work for the benefit of the readers of “Clinics.” We searched through PUBMED for noteworthy articles published in Brazilian medical journals included in the Journal of Citation Reports of the Institute of Scientific Information to better expose them to our readership. The following journals were examined: “Arquivos Brasileiros de Cardiologia,” “Arquivos Brasileiros de Endocrinologia e Metabologia,” “Brazilian Journal of Medical and Biological Reviews,” “Jornal Brasileiro de Pneumologia,” “Jornal de Pediatria,” “Revista Brasileira de Cirurgia Cardiovascular,” “Revista da Associação Médica Brasileira,” Revista da Escola de Enfermagem U.S.P.” and “São Paulo Medical Journal.” These journals publish original investigations in the field of cardiopulmonary disease. The search produced 71 references, which are briefly examined.

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Prevalência da doença do refluxo gastroesofágico em pacientes com fibrose pulmonar idiopática

Cited by 38 publications

References 22 publications

Pleiotropic effect of the proton pump inhibitor esomeprazole leading to suppression of lung inflammation and fibrosis

Pleiotropic effect of the proton pump inhibitor esomeprazole leading to suppression of lung inflammation and fibrosis

Pepsin concentrations are elevated in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis after lung transplantation

A review of cardiopulmonary research in Brazilian medical journals: clinical, surgical and epidemiological data

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