Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal interstitial lung disease (ILD) of unknown etiology. Introduction of acid into the respiratory tree can produce pulmonary fibrosis. Gastroesophageal reflux (GER) has previously been associated with several other respiratory conditions, incl...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 1998-12, Vol.158 (6), p.1804-1808
Main Authors: TOBIN, R. W, POPE, C. E, PELLEGRINI, C. A, EMOND, M. J, SILLERY, J, RAGHU, G
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Aged, 80 and over
Asthma - etiology
Biological and medical sciences
Biopsy
Bronchitis - etiology
Circadian Rhythm
Esophagus - physiopathology
Female
Gastric Acid
Gastroesophageal Reflux - complications
Gastroesophageal Reflux - physiopathology
Heartburn - etiology
Humans
Hydrogen-Ion Concentration
Male
Medical sciences
Middle Aged
Monitoring, Ambulatory
Pneumology
Pneumonia - etiology
Posture
Prevalence
Prospective Studies
Pulmonary Diffusing Capacity
Pulmonary Fibrosis - etiology
Respiratory system : syndromes and miscellaneous diseases
Sex Factors
Supine Position
Time Factors
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Summary:Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal interstitial lung disease (ILD) of unknown etiology. Introduction of acid into the respiratory tree can produce pulmonary fibrosis. Gastroesophageal reflux (GER) has previously been associated with several other respiratory conditions, including pneumonia, bronchitis, and asthma. To investigate prospectively the possible association of GER and IPF, 17 consecutive patients with biopsy-proven IPF and eight control patients with ILD other than IPF underwent dual-channel, ambulatory esophageal pH monitoring. Sixteen of 17 patients with IPF had abnormal distal and/or proximal esophageal acid exposure compared with four of eight control patients (p = 0.02). In the patients with IPF, mean percent distal total (13.6 versus 3.34, p = 0.006), distal upright (12.4 versus 5.1, p = 0.04), distal supine (14.7 versus 0.88, p = 0.02), and proximal supine (7.48 versus 0.24, p = 0.04) esophageal acid exposure times were significantly greater than those in control patients. Only four patients with IPF (25%) with increased acid exposure had typical reflux symptoms such as heartburn or regurgitation. Patients with IPF have a high prevalence of increased esophageal acid exposure, usually without typical GER symptoms. GER in these patients tends to occur at night and extend into the proximal esophagus. Acid reflux may be a contributing factor in the pathogenesis of IPF.
ISSN:1073-449X
1535-4970
DOI:10.1164/ajrccm.158.6.9804105