Gastroesophageal Reflux Disease in Idiopathic Pulmonary Fibrosis: Viewer or Actor? To Treat or Not to Treat?

Abstract

Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a median survival of ∼3 years. Several risk factors have been identified, such as age, genetic predisposition, tobacco exposure, and gastro-oesophageal reflux disease (GERD). Prevalence of GERD in IPF is high and may affect 87% of patients, of whom only half (47%) report symptoms. Objective: The aim of this study is to review current evidence regarding the correlation between GERD and IPF and to evaluate the current studies regarding treatments for GERD-IPF. Methods: A review to identify research papers documenting an association between GERD and IPF was performed. Results: We identified several studies that have confirmed the association between GERD and IPF, with an increased acid exposure, risk of gastric aspiration and bile acids levels in these patients. Few studies focused their attention on GERD treatment, showing how antiacid therapy was not able to change IPF evolution. Conclusions: This review investigating the correlation between GERD and IPF has confirmed the hypothesized association. However, further large prospective studies are needed to corroborate and elucidate these findings with a focus on preventative and treatment strategies.

Keywords: bronchoalveolar lavage fluid (BALF); gastro-oesophageal reflux disease (GERD); high-resolution computed tomography (HRTC); idiopathic pulmonary fibrosis (IPF); interstitial lung disease (ILD); interstitial pneumonia.

Figure 1

Axial chest CT images of a 73-year-old male with established IPF. (A) High-resolution image shows fibrotic changes due to the presence of diffuse irregular thickening of interlobular septa, traction bronchiectasis/bronchiolectasis, and honeycombing (black arrow); moreover, distortion of oblique fissure is visible. (B) CT also demonstrates the presence of a gastric (thoracic) hiatus hernia (white arrow).