Gastro-oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients

Abstract

The aim of the study was to characterise gastro-oesophageal reflux (GOR) in idiopathic pulmonary fibrosis (IPF).40 consecutive IPF patients underwent pulmonary high-resolution computed tomography (HRCT) scan and impedance-pH monitoring while off antisecretory therapy. The presence of pulmonary fibrosis was assessed using validated HRCT scores. Reflux features included distal oesophageal acid exposure, number of acid/weakly acidic reflux episodes and their proximal migration. 40 consecutive patients with interstitial lung disease other than IPF (non-IPF patients) and 50 healthy volunteers were also enrolled.IPF patients had significantly higher (p,0.01) oesophageal acid exposure (median (interquartile range (IQR)) 9.25 (4.7-15.4)% versus 3.3 (1.4-7.4)% versus 0.7 (0.2-4.2)%, number of acid (median (IQR) 45 (23-55) versus 32 (19-44) versus 18 (10-31)), weakly acidic (median (IQR) 34 (19-43) versus 21 (11-33) versus 18 (15-28)) and proximal reflux (median (IQR) 51 (26.5-65.5) versus 20 (9.5-34.5) versus 9 (5-20)) events compared to non-IPF patients and healthy volunteers, respectively. Pulmonary fibrosis HRCT scores correlated well with reflux episodes in both the distal (r 2 50.567) and proximal (r 2 50.6323) oesophagus. Patients with IPF had more bile acids and pepsin (p,0.03) in bronchoalveolar lavage fluid (BALF) (62% and 67%, respectively) and saliva (61% and 68%, respectively) than non-IPF patients (25% and 25% in BALF, and 33% and 36%, respectively, in saliva) and controls (0% and 0% in BALF and saliva, respectively).Acid GOR is common in IPF, but weakly acidic GOR may also occur. Patients with IPF had a risk of pulmonary aspiration of gastric contents. Outcome studies with intense antireflux therapy are needed. @ERSpublications Frequent acid/weakly acidic gastro-oesophageal reflux and high risk of pulmonary aspiration of gastric contents in IPF http://ow.ly/nSNv8

Overexpression of farnesoid X receptor in small airways contributes to epithelial to mesenchymal transition and COX-2 expression in chronic obstructive pulmonary disease

“…Over a long time, gastric acid has been conceived as the dominant toxic agent in GER-associated lung diseases. However, the role of non-acid gastric contents is increasingly recognized in GERD-associated lung diseases (35)(36)(37). Our data indicated that bile acids aspiration may promote airway inflammation via FXR-mediated COX-2 expression, providing a novel insight of the association between GERD and COPD exacerbations.…”

A Clinical and Radiological Profile of Patients of Interstitial Lung Diseases, Attending the Chest Hospital of Medical College From North India

“…9 Another study done by Savarino E et al finds IPF patients had significantly higher (p<0.01) oesophageal acid exposure 9.25 (4.7-15.4%) versus 3.3 (1.4-7.4%) versus 0.7 (0.2-4.2%) as compared to non-IPF patients and healthy volunteers, respectively. 18 Schwartz DA et al done a study in 73 confirmed cases of IPF and of them 62% were men and 70% were either former or current cigarette smokers.…”

“…9 In our study, sarcoidosis was more commonly seen in females (85.7%) and which is supported by most studies, which suggest a slightly higher disease rate for women. 18 Benjamin et al studied and found that the female preponderance of sarcoidosis appears to be consistent across ethnic groups. 20 Mean age of presentation of sarcoidosis in our study 43.7±3.6SD years.…”

Esophageal testing: What we have so far

“…Moreover, the more frequent request to evaluate patients refractory to therapy with proton pump inhibitors (PPIs) has provided further impetus in this direction [11][12][13] . Finally, it is relevant to bear in mind the increasing referral to our outpatient clinics of subjects with extraesophageal symptoms suggestive of GERD, such as laryngeal and pulmonary symptoms, representing a true challenge in our clinical practice due to the difficulties in evaluating the potential relationship of their symptoms and GERD with appropriate management [14,15] . In this context, the advent of novel esophageal function testing, such as impedance-pH monitoring (MII-pH) and high resolution manometry (HRM), has allowed for relevant progress in the understanding of the pathophysiological mechanisms contributing to the development of GERD and, thereafter, its diagnosis and management.…”