Gastro-oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients

The aim of the study was to characterise gastro-oesophageal reflux (GOR) in idiopathic pulmonary fibrosis (IPF). 40 consecutive IPF patients underwent pulmonary high-resolution computed tomography (HRCT) scan and impedance-pH monitoring while off antisecretory therapy. The presence of pulmonary fibrosis was assessed using validated HRCT scores. Reflux features included distal oesophageal acid exposure, number of acid/weakly acidic reflux episodes and their proximal migration. 40 consecutive patients with interstitial lung disease other than IPF (non-IPF patients) and 50 healthy volunteers were also enrolled. IPF patients had significantly higher (p<0.01) oesophageal acid exposure (median (interquartile range (IQR)) 9.25 (4.7–15.4)% versus 3.3 (1.4–7.4)% versus 0.7 (0.2–4.2)%, number of acid (median (IQR) 45 (23–55) versus 32 (19–44) versus 18 (10–31)), weakly acidic (median (IQR) 34 (19–43) versus 21 (11–33) versus 18 (15–28)) and proximal reflux (median (IQR) 51 (26.5–65.5) versus 20 (9.5–34.5) versus 9 (5–20)) events compared to non-IPF patients and healthy volunteers, respectively. Pulmonary fibrosis HRCT scores correlated well with reflux episodes in both the distal (r2=0.567) and proximal (r2=0.6323) oesophagus. Patients with IPF had more bile acids and pepsin (p<0.03) in bronchoalveolar lavage fluid (BALF) (62% and 67%, respectively) and saliva (61% and 68%, respectively) than non-IPF patients (25% and 25% in BALF, and 33% and 36%, respectively, in saliva) and controls (0% and 0% in BALF and saliva, respectively). Acid GOR is common in IPF, but weakly acidic GOR may also occur. Patients with IPF had a risk of pulmonary aspiration of gastric contents. Outcome studies with intense antireflux therapy are needed. Frequent acid/weakly acidic gastro-oesophageal reflux and high risk of pulmonary aspiration of gastric contents in IPF http://ow.ly/nSNv8

[1]  O. Hilberg,et al.  Idiopathic Pulmonary Fibrosis - Diagnosis and Treatment , 2014 .

[2]  H. Collard,et al.  Bronchoalveolar lavage pepsin in acute exacerbation of idiopathic pulmonary fibrosis , 2011, European Respiratory Journal.

[3]  H. Collard,et al.  Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis. , 2011, American journal of respiratory and critical care medicine.

[4]  E. Savarino,et al.  The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease. , 2011, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[5]  A. Morice,et al.  Gastroesophageal reflux and idiopathic pulmonary fibrosis: a prospective study. , 2011, Medicina.

[6]  G. Verleden,et al.  Gastric Juice From Patients “On” Acid Suppressive Therapy Can Still Provoke a Significant Inflammatory Reaction by Human Bronchial Epithelial Cells , 2010, Journal of clinical gastroenterology.

[7]  E. Savarino,et al.  Characteristics of Reflux Episodes and Symptom Association in Patients With Erosive Esophagitis and Nonerosive Reflux Disease: Study Using Combined Impedance–pH Off Therapy , 2010, The American Journal of Gastroenterology.

[8]  S. Savvidou.  Serum Adiponectin Concentration Decreases in Higher Stages of Hepatic Fibrosis Within the Entire Clinicopathologic Spectrum of Nafld , 2010 .

[9]  E. Savarino,et al.  Functional heartburn has more in common with functional dyspepsia than with non-erosive reflux disease , 2009, Gut.

[10]  E. Savarino,et al.  Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using pH-impedance monitoring. , 2009, American journal of respiratory and critical care medicine.

[11]  R. Bollinger,et al.  Pulmonary Histopathology in an Experimental Model of Chronic Aspiration Is Independent of Acidity , 2008, Experimental biology and medicine.

[12]  G. Verleden,et al.  Gastro-oesophageal reflux and aspiration of gastric contents in adult patients with cystic fibrosis , 2008, Gut.

[13]  Gary K Grunwald,et al.  Idiopathic pulmonary fibrosis: physiologic tests, quantitative CT indexes, and CT visual scores as predictors of mortality. , 2008, Radiology.

[14]  E. Savarino,et al.  Combined multichannel intraluminal impedance and manometry testing. , 2008, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[15]  J. Smith,et al.  Pepsin, a biomarker of gastric aspiration in lung allografts: a putative association with rejection. , 2007, American journal of respiratory and critical care medicine.

[16]  J. Golden,et al.  Gastroesophageal reflux in patients with idiopathic pulmonary fibrosis referred for lung transplantation. , 2007, The Journal of thoracic and cardiovascular surgery.

[17]  K. C. Lewis.  High prevalence of abnormal acid gastro-oesopheagel reflux in idiopathic pulmonary fibrosisRaghu G, Freudenberg TD, Yang S, et al (Univ of Washington, Seattle; Singapore Gen Hosp) Eur Respir J 27:136-142, 2006§ , 2007 .

[18]  M. K. Han,et al.  High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis , 2006, European Respiratory Journal.

[19]  E. Savarino,et al.  Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. , 2006, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[20]  G. Raghu,et al.  Sole treatment of acid gastroesophageal reflux in idiopathic pulmonary fibrosis: a case series. , 2006, Chest.

[21]  D. Sugarbaker,et al.  Laparoscopic fundoplication in patients with end-stage lung disease awaiting transplantation. , 2006, The Journal of thoracic and cardiovascular surgery.

[22]  D. Gibson,et al.  Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration. , 2006, Journal of pediatric surgery.

[23]  J. Koufman,et al.  Sensitive Pepsin Immunoassay for Detection of Laryngopharyngeal Reflux , 2005, The Laryngoscope.

[24]  M. Vaezi,et al.  The role of pH monitoring in extraesophageal gastroesophageal reflux disease. , 2005, Gastrointestinal endoscopy clinics of North America.

[25]  E. Savarino,et al.  Combined multichannel intraluminal impedance and pH-metry: a novel technique to improve detection of gastro-oesophageal reflux literature review. , 2004, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[26]  J. Dent,et al.  Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux , 2004, Gut.

[27]  D. Castell,et al.  Use of multichannel intraluminal impedance to document proximal esophageal and pharyngeal nonacidic reflux episodes. , 2003, The American journal of medicine.

[28]  Paul J. Friedman,et al.  American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors , 2002, American journal of respiratory and critical care medicine.

[29]  A. Ing.  Interstitial lung disease and gastroesophageal reflux. , 2001, The American journal of medicine.

[30]  S. Spechler,et al.  Classification of oesophageal motility abnormalities , 2001, Gut.

[31]  Arnold Simanowitz,et al.  international consensus statement , 2000 .

[32]  David A. Lynch,et al.  Idiopathic pulmonary fibrosis: Diagnosis and treatment: International Consensus Statement , 2000 .

[33]  G. Raghu,et al.  Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. , 1998, American journal of respiratory and critical care medicine.

[34]  D. Cramer.  Standardization of the measurement of transfer factor. , 1993, The European respiratory journal.

[35]  J. Roca,et al.  Standardization of the measurement of transfer factor (diffusing capacity) , 1993, European Respiratory Journal.

[36]  J. Roca,et al.  Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[37]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[38]  J E Cotes,et al.  Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[39]  C. Kallenberg.  Overlapping syndromes, undifferentiated connective tissue disease, and other fibrosing conditions , 1992, Current opinion in rheumatology.

[40]  P. O'Byrne,et al.  Is nedocromil sodium effective treatment for asthma? , 1993, The European respiratory journal.

[41]  M. Green,et al.  Thoracoabdominal mechanics during tidal breathing in normal subjects and in emphysema and fibrosing alveolitis. , 1983, Thorax.

[42]  J F Fries,et al.  The 1982 revised criteria for the classification of systemic lupus erythematosus. , 1982, Arthritis and rheumatism.

[43]  E. Wiener.  Gastroesophageal reflux and pulmonary aspiration: Incidence, Functional abnormality, and results of surgical therapy , 1980 .

[44]  C. Pellegrini,et al.  Gastroesophageal reflux and pulmonary aspiration: incidence, functional abnormality, and results of surgical therapy. , 1979, Surgery.

[45]  E. Mays,et al.  Pulmonary fibrosis associated with tracheobronchial aspiration. A study of the frequency of hiatal hernia and gastroesophageal reflux in interstitial pulmonary fibrosis of obscure etiology. , 1976, Chest.

[46]  J. Gustafson,et al.  Cystic Fibrosis , 2009, Journal of the Iowa Medical Society.

[47]  Moran Tj.  Experimental aspiration pneumonia. IV. Inflammatory and reparative changes produced by intratracheal injections of autologous gastric juice and hydrochloric acid. , 1955 .

[48]  T. Moran.  Experimental aspiration pneumonia. IV. Inflammatory and reparative changes produced by intratracheal injections of autologous gastric juice and hydrochloric acid. , 1955, A.M.A. archives of pathology.