Gastroesophageal Reflux Disease Is a Risk Factor for Severity of Organizing Pneumonia

Abstract

Background: The link between organizing pneumonia (OP) and gastroesophageal reflux disease (GERD) is not well known. There is little evidence in the literature to establish a causal link between GERD and OP. Objectives: The aim of the study was to assess the hypothesis that OP is more severe when it is associated with GERD and that it leads to more frequent relapses. Methods: In a retrospective study on 44 patients suffering from OP, we compared the clinical, radiological and histological characteristics of 2 groups, 1 composed of patients with GERD (n = 20) and the other of patients without GERD (n = 24). Results: The GERD group was distinguished by a higher number of patients with migratory alveolar opacities on chest radiography and thoracic computerized tomography (14/20 vs. 9/24; p = 0.03 and 18/20 vs. 13/24; p = 0.01), greater hypoxemia [60 (42-80) vs. 70 (51-112) mm Hg; p = 0.03], greater bronchoalveolar lavage cellularity [0.255 (0.1-1.8) vs. 0.150 (0.05-0.4) g/l; p = 0.035] and more frequent relapses (14/20 vs. 9/24; p = 0.03). Conclusions: OP associated with GERD is more severe and results in more frequent relapses. Microinhalation of gastric secretions might induce lung inflammation leading to OP and relapse. We suggest that typical symptoms of GERD such as pyrosis should be investigated in OP.

A Case of Cryptogenic Organizing Pneumonia Managed without a Diagnostic Biopsy

“…About 33% of patients who are treated for less than one year with corticosteroids experience recurrence. 13 Studies have shown that relapse is associated with multiple factors such as gastroesophageal reflux disease, a decrease in functional vital capacity, a decrease in serum protein, and severity of illness at diagnosis. 2,14,15 Lazor et al studied relapses in 48 cases and found that a delay in initial diagnosis was also associated with an increase in relapse.…”

Dangerous Liaisons? Gastroesophageal Reflux Disease and Organizing Pneumonia

“…In the last issue of Respiration , Gaillet et al [1] report on the significance of gastroesophageal reflux disease (GERD) as a risk factor for the severity of organizing pneumonia (OP). In their series, patients with OP and GERD had more extensive radiological involvement, greater hypoxemia and greater bronchoalveolar lavage cellularity compared to those with OP in the absence of GERD.…”

“…BOOP as a manifestation of aspiration rather than rejection has also been reported after lung transplantation [27]. The study by Gaillet et al [1] examined the association between OP and GERD more closely. The prevalence of GERD in the study population was 45%, which exceeds the 20-30% seen in the general population.…”

“…Equally important, GERD can be clinically silent: half of the patients with IPF and GERD do not report classic GERD symptoms, and this also applies to patients after lung transplantation [10,15]. In the study by Gaillet et al [1], GERD was excluded based on invasive assessments only in 8% of the patients in the GERD-negative group, although none of these patients had symptoms suggesting regurgitation.…”

“…Several factors have been associated with an increased frequency of relapses in OP: hypoxemia at presentation, elevated serum glutamyl transferase and alkaline phosphatase levels, the degree of collagen fibrosis in the interstitium and delayed treatment of the first episode [20,24,28]. In the study by Gaillet et al [1], the presence of GERD was associated with more relapses, which, however, did not result in significant clinical or physiological sequelae, since the total dose of corticosteroids used, hospitalizations and respiratory failure events were similar in the two groups. The authors did not find a difference in the frequency of other relapse-associated factors between the GERD-positive and GERD-negative groups, including the degree of collagen fibrosis (although the number of biopsies available was relatively small).…”