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J Gastrointest Surg. 2014 Jan;18(1):100-4; discussion 104-5. doi: 10.1007/s11605-013-2333-z. Epub 2013 Sep 4.

Idiopathic pulmonary fibrosis and gastroesophageal reflux. Implications for treatment.

Author information

1
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.

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.

AIMS:

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.

PMID:
24002768
DOI:
10.1007/s11605-013-2333-z
[Indexed for MEDLINE]

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