High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis.
The aim of this prospective study was to determine the prevalence and characteristics of acid gastro-oesophageal reflux (GER) in patients with idiopathic pulmonary fibrosis (IPF). Sixty-five consecutive patients with well-defined IPF were subjected to 24-h pH monitoring and oesophageal manometry. A total of 133 consecutive patients with intractable asthma and symptoms of GER were used as comparisons. The prevalence of abnormal acid GER in IPF patients was 87%, with 76% and 63% demonstrating abnormal distal and proximal oesophageal acid exposures, respectively. Abnormal acid GER was significantly more common in IPF patients than asthma patients. Only 47% of IPF patients experienced classic GER symptoms. Despite treatment with standard doses of proton pump inhibitors (PPIs), 12 out of 19 patients receiving PPIs during the 24-h pH monitoring had abnormal oesophageal acid exposures by pH probe. There was no correlation between IPF severity and acid GER severity. In conclusion, abnormal acid gastro-oesophageal reflux is highly prevalent, but often clinically occult in patients with idiopathic pulmonary fibrosis. Standard doses of proton pump inhibitors may not suppress the acid gastro-oesophageal reflux in this population. Therefore, further studies are needed to determine if acid abnormal gastro-oesophageal reflux represents an important risk factor for idiopathic pulmonary fibrosis development or progression, and if optimal suppression of acid gastro-oesophageal reflux slows the progression of idiopathic pulmonary fibrosis and/or decreases episodic exacerbations of idiopathic pulmonary fibrosis.
Raghu
G
G
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98195, USA. graghu@u.washington.edu
Freudenberger
T D
TD
Yang
S
S
Curtis
J R
JR
Spada
C
C
Hayes
J
J
Sillery
J K
JK
Pope
C E
CE
Pellegrini
C A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D015995:Prevalence; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D011658:Pulmonary Fibrosis / Q000150:complications*; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric
D054328:Proton Pump Inhibitors