GER and Aspiration in Interstitial Lung Disease

Meyer, Keith C.; Raghu, Ganesh

doi:10.1007/978-1-4614-5502-8_10

Cited by 3 publications

(6 citation statements)

References 107 publications

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“…The aspiration of large volumes of gastric content to the lungs can result in several patterns of injury [ 31 ]. Inflammation, scarring and bronchiolar metaplasia in the centrilobular zones of the lung were identified in cases of chronic aspiration in humans [ 16 ] and in an experimental model [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Inflammation, scarring and bronchiolar metaplasia in the centrilobular zones of the lung were identified in cases of chronic aspiration in humans [ 16 ] and in an experimental model [ 32 ]. Microaspiration of the gastric contents has been extensively evaluated in patients with IPF and in systemic sclerosis and other CTDs [ 31 ]. In scleroderma, a disease in which GERD is common, centrilobular fibrosis was described in 21% of 28 lung biopsies [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Airway-centered interstitial fibrosis: etiology, clinical findings and prognosis

et al. 2015

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BackgroundAirway-centered Interstitial Fibrosis (ACIF) is a common pathologic pattern observed in our practice.ObjectivesThe objectives of this study are to describe the causes associated with ACIF in a large sample of patients and its effect on survival.MethodsA retrospective study in three centers of interstitial lung disease in São Paulo, between January of 1995 and December of 2012. The surgical lung biopsy specimens were reviewed by three pathologists. The clinical, functional and tomographic findings were analyzed by a standardized protocol.ResultsThere were 68 cases of ACIF, most of them women. The mean age was 57 ± 12 yr. Dyspnea, cough, restrictive pattern at spirometry and oxygen desaturation at exercise were common. A reticular pattern with peribronchovascular infiltrates was found in 79% of the cases. The etiologies of ACIF were hypersensitivity pneumonitis in 29 (42.6%), gastroesophageal reflux disease in 17 (25.0%), collagen vascular disease in 4 (5.9%), a combination of them in 15 cases and idiopathic in 3 (4.4%). The median survival was 116 months (95% CI = 58.5 – 173.5). Lower values of oxygen saturation at rest, presence of cough and some histological findings - organizing tissue in the airways, fibroblastic foci and microscopic honeycombing - were predictors of worse survival.ConclusionsACIF is an interstitial lung disease with a better survival when compared with IPF. The main etiologies are HP and GERD. The oxygen saturation at rest, the presence of cough and some histological findings are predictors of survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Airway-centered interstitial fibrosis: etiology, clinical findings and prognosis

et al. 2015

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“…There is increasing awareness that an abnormal degree of gastroesophageal reflux (GER) combined with aspiration may play a significant role in the pathogenesis of a number of forms of ILD [ 13 , 14 ]. GER disease (GERD) has been associated with IPF and with pulmonary fibrosis in patients with systemic sclerosis (scleroderma), and GER with aspiration may play a role in triggering and/or driving lung inflammation and fibrosis in IPF and scleroderma, and it has been linked to acute exacerbations in patients with IPF [ 15 , 16 ].…”

Section: Reviewmentioning

confidence: 99%

Diagnosis and management of interstitial lung disease

2014

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The complex tasks of making a confident diagnosis of a specific form of interstitial lung disease (ILD) and formulating a patient-centered, personalized management plan in an attempt to achieve remission or stabilization of the disease process can pose formidable challenges to clinicians. When patients are evaluated for suspected ILD, an accurate diagnosis of the specific form of ILD that a patient has developed must be made to provide the patient with useful prognostic information and to formulate an appropriate management plan that can relieve symptoms and restore or significantly improve quality of life. A well-performed patient history and physical examination provides invaluable information that can be combined with appropriate laboratory testing, imaging, and, if needed, tissue biopsy to reach a confident ILD diagnosis, and high-resolution computed tomography (HRCT) of the thorax is usually a key component of the diagnostic evaluation. If treatment is indicated, many forms of ILD can respond significantly to immunosuppressive anti-inflammatory therapies. However, ILD accompanied by extensive fibrosis may be difficult to treat, and the identification of an effective pharmacologic therapy for idiopathic pulmonary fibrosis (IPF) has remained elusive despite the completion of many phase 3 clinical trials over the past decade. Nonetheless, patients with IPF or advanced forms of non-IPF ILD can benefit significantly from detection and treatment of various co-morbid conditions that are often found in patients (especially the elderly patient), and supportive care (oxygen therapy, pulmonary rehabilitation) can have a beneficial impact on quality of life and symptom palliation. Finally, lung transplantation is an option for patients with progressive, advanced disease that does not respond to other therapies, but only a relatively small subset of patients with end-stage ILD are able to meet wait listing requirements and eventually undergo successful lung transplantation.

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“…Bronchiolar metaplasia, inflammation and fibrosis with centrilobular distribution have been described in patients with chronic aspiration. In both IPF and systemic sclerosis, elements of centrilobular fibrosis on biopsy can result from microaspiration …”

Section: Bpipmentioning

confidence: 99%

“…In both IPF and systemic sclerosis, elements of centrilobular fibrosis on biopsy can result from microaspiration. [80][81][82] Taken together, it can be argued that the six series encompass a spectrum of airway-centred injury triggered variably by a variety of possible causes and associations such as airborne exposures, GORD and immune dysregulation. Given a total experience of 148 biopsied patients (and recognizing that larger numbers of non-biopsied patients must inevitably lie within this spectrum of disease), it is appropriate to consider whether BPIP should be viewed as a novel clinical syndrome.…”

Section: Ippfementioning

confidence: 99%

Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP

et al. 2015

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In the 2013 reclassification of the idiopathic interstitial pneumonias (IIPs), two rare IIPs (idiopathic lymphoid interstitial pneumonia (LIP), idiopathic pleuroparenchymal fibroelastosis (IPPFE)) and two rare histologic patterns (acute fibrinous and organizing pneumonia (AFOP), bronchiolocentric pattern of interstitial pneumonia (BPIP)) are described. All these entities are rare with small series published to date, mostly containing primary and secondary forms of disease. LIP is histologically characterized by diffuse polyclonal lymphoid cell infiltrate surrounding the airways and expanding the interstitium. Thin-walled cysts and diffuse ground glass are considered the typical radiologic features. The clinical course is highly variable with corticosteroid responsiveness evident in approximately half of cases. IPPFE is defined histologically by coexisting upper lobe pleural and intraalveolar fibrosis with elastosis. Dense subpleural irregular fibrosis and consolidation are the cardinal radiologic features. A history of recurrent lower respiratory tract infection is frequent. Responses to immunomodulation have not been reported and the rate of progression appears to be highly variable. AFOP is a rare histologic pattern lying within the spectrum of acute/subacute lung injury, characterized by organizing pneumonia and intra-alveolar fibrin deposition without hyaline membranes. BPIP is characterized histologically by fibrosis and/or inflammation confined to the alveolar interstitium around bronchovascular bundles, overlapping with peribronchial metaplasia and fibrosis in some series. Currently, AFOP and BPIP are both best viewed as histological entities rather than true clinical disorders, in the absence of characteristic associated imaging patterns and clinical features.

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GER and Aspiration in Interstitial Lung Disease

Cited by 3 publications

References 107 publications

Airway-centered interstitial fibrosis: etiology, clinical findings and prognosis

Airway-centered interstitial fibrosis: etiology, clinical findings and prognosis

Diagnosis and management of interstitial lung disease

Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP

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