Background Idiopathic pulmonary fibrosis (IPF) is a progressive condition with limited treatment options and median survival of 3–5 years. Gastro-oesophageal reflux (GOR) has been described in up to 90% of patients. Pulmonary aspiration has been suggested to contribute to IPF, with calls for aggressive antireflux therapy. We investigated reflux and aspiration in an unselected IPF cohort.
Methods Symptoms were assessed using a validated questionnaire. Patients with IPF underwent oesophageal manometry, pH-impedance analysis and a standardised bronchoalveolar lavage (BAL). Pepsin and bile salts were quantified in lavage supernatant using a validated ELISA and tandem mass spectrometry, respectively. Patient management was planned by an “aerodigestive” multidisciplinary team.
Results 35 patients were studied. Oesophageal manometry suggested normal oesophageal function in 46%. pH-impedance demonstrated supranormal GOR in 24 patients (69%). In nine of these, the combination of clinical history and structured questionnaire revealed no evidence of GORD. BAL pepsin concentrations were higher than those measured in four healthy volunteer controls: median 9.0 ng/ml (range 0–35) vs 1.1 ng/ml (0–3); p = 0.02. Bile salt concentrations were comparable in the two groups. To date, none of these patients have undergone fundoplication.
Discussion Oesophageal physiology and BAL assays may be combined to investigate reflux and aspiration in IPF. Our data suggest that acid reflux and weakly acid reflux is common and frequently asymptomatic. Our study suggests the need for carefully integrated assessments to inform potential treatment of reflux in IPF. High levels of oesophageal dysmotility and patient complexity support a cautious approach to antireflux surgery, which may be facilitated by multidisciplinary review.
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