Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis

Abstract

Rationale: Gastroesophageal reflux (GER) is highly prevalent in patients with idiopathic pulmonary fibrosis (IPF). Chronic microaspiration secondary to GER may play a role in the pathogenesis and natural history of IPF.

Objectives: To investigate the relationship between GER-related variables and survival time in patients with IPF.

Methods: Regression analysis was used to investigate the relationship between GER-related variables and survival time in a retrospectively identified cohort of patients with well-characterized IPF from two academic medical centers.

Measurements and main results: Two hundred four patients were identified for inclusion. GER-related variables were common in this cohort: reported symptoms of GER (34%), a history of GER disease (45%), reported use of GER medications (47%), and Nissen fundoplication (5%). These GER-related variables were significantly associated with longer survival time on unadjusted analysis. After adjustment, the use of GER medications was an independent predictor of longer survival time. In addition, the use of gastroesophageal reflux medications was associated with a lower radiologic fibrosis score. These findings were present regardless of center.

Conclusions: The reported use of GER medications is associated with decreased radiologic fibrosis and is an independent predictor of longer survival time in patients with IPF. These findings further support the hypothesis that GER and chronic microaspiration may play important roles in the pathobiology of IPF.

Figure 1.

(A) Survival time estimates based on presence or absence of gastroesophageal reflux (GER) symptoms. Median survival time for those with GER symptoms was 1,499 days and median survival time for those without GER symptoms was 941 days. (B) Survival time estimates based on presence or absence of reported GER disease. Median survival time for those with GER disease was 1,499 days and those without GER disease was 920 days. (C) Survival time estimates based on reported GER medication use (either proton pump inhibitors or H2 blockers). Median survival time for those taking GER medications was 1,967 days and median survival time for those not taking GER medications was 896 days. (D) Survival time estimates based on presence or absence of a history of Nissen fundoplication. Median survival time for those with a history of Nissen fundoplication was 2,252 days and median survival time for those without a history of Nissen fundoplication was 1,019 days.