title: Idiopathic pulmonary fibrosis and gastroesophageal reflux. Implications for treatment.
abstract: BACKGROUND
  Even though the pathogenesis of idiopathic pulmonary fibrosis (IPF) is unknown, there is mounting evidence that abnormal reflux (GERD) and aspiration of gastric contents may play a role in the pathogenesis of this disease.
  
  
  OBJECTIVE
  The aims of this study were to determine in patients with GERD and IPF: (a) the clinical presentation, (b) the esophageal function, and (c) the reflux profile.
  
  
  METHODS
  We compared the clinical presentation, the esophageal function (as defined by high-resolution manometry), and the reflux profile (by dual sensor pH monitoring) in 80 patients with GERD (group A) and in 22 patients with GERD and IPF (group B).
  
  
  RESULTS
  Heartburn was present in less than 60 % of patients with GERD and IPF. Lower esophageal sphincter pressure and peristalsis were normal in both groups, while the upper esophageal sphincter (UES) was more frequently hypotensive in IPF patients (p = 0.008). In patients with GERD and IPF, the proximal esophageal acid exposure was higher (p = 0.047) and the supine acid clearance was slower as compared with patients with GERD only (p < 0.001).
  
  
  CONCLUSIONS
  The results of this study show that in patients with GERD and IPF: (a) reflux is frequently silent, (b) with the exception of a weaker UES, the esophageal function is preserved, and (c) proximal reflux is more common, and in the supine position, it is coupled with a slower acid clearance. Because these factors predisposing IPF patients to the risk of aspiration, antireflux surgery should be considered early after the diagnosis of IPF and GERD is established.
authors.affiliation: Center for Esophageal Diseases, Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, MC 5031, Room G-207, Chicago, IL, 60637, USA.
authors.forename: Marco E
authors.initials: ME
authors.lastname: Allaix
authors.forename: Piero M
authors.initials: PM
authors.lastname: Fisichella
authors.forename: Imre
authors.initials: I
authors.lastname: Noth
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Herbella
authors.forename: Bernardo
authors.initials: B
authors.lastname: Borraez Segura
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D000328:Adult; D000368:Aged; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology*; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology*; D006356:Heartburn / Q000209:etiology; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D011859:Radiography; D012189:Retrospective Studies