Antireflux surgery in idiopathic pulmonary fibrosis

Non-randomised data have demonstrated high prevalence of gastro-oesophageal reflux disease (GORD) in patients with idiopathic pulmonary fibrosis (IPF) and postulated a potential role in disease progression. However, interventional studies examining medical treatment of GORD in patients with IPF have had mixed outcomes. Raghu et al (Lancet Resp Med 2018;6:707–714) performed a randomised controlled trial examining the rate of decline in FVC after laparoscopic antireflux surgery in patients with IPF with significant GORD demonstrated on pH manometry. About 58 patients were randomised 1:1 to either antireflux surgery or the non-surgery group. Change in FVC was monitored over a 48-week period postrandomisation. Surgery was effective in normalising reflux. Although numerically lower, there was no significant difference in rate of decline in FVC in the surgical group (−0.05 L (95% CI −0.15 to 0.05)) when compared with the non-surgical group (−0.13 L (−0.23 to −0.02)) (p=0.28). Again the secondary outcomes showed no significant difference in the rate of acute exacerbation, respiratory-related hospitalisation or death between the two groups, although with trends towards favouring surgical intervention. There were few serious adverse events in the surgical group. This study establishes antireflux surgery as safe in patients with IPF and confirmed …