Interstitial lung disease and gastroesophageal reflux
Section snippets
Idiopathic pulmonary fibrosis
Although the etiology remains unknown, conditions virtually identical to IPF have been described after exposure to such known agents as asbestos, paraquat, Epstein-Barr virus, and wood smoke. In addition, ILD that is associated with rheumatoid arthritis and systemic lupus erythematosus may be histologically inseparable from IPF. In “lone IPF,” in which no evidence of a specific etiology or multisystem disorder exists, a number of proposed initiating mechanisms have been investigated; GER has
Systematic sclerosis
Pulmonary involvement in systemic sclerosis is common, and in postmortem studies, nearly all patients have evidence of IPF.13 Other well-recognized pulmonary complications include pulmonary arterial hypertension (in which pulmonary vascular damage dominates the clinical picture), extrapulmonary restriction, and aspiration pneumonia secondary to esophageal involvement. Because esophageal involvement in systemic sclerosis is also common, it is difficult to determine whether GER and ILD, when
Other interstitial lung diseases
Other ILDs associated with GER have not been systematically studied and are represented in the literature only as sporadic case reports or uncontrolled series. Reid et al18 reported a series of 11 patients who had heart-lung transplants. Five patients developed obliterative bronchiolitis after transplantation. All 5 had evidence of abnormal gastric emptying and aspiration as measured by nuclear gastric emptying studies, barium swallow, and esophageal manometry. Obliterative bronchiolitis
Conclusions
ILDs are a large, heterogeneous group of pulmonary disorders, and it appears that GER is at least associated with 2 of these entities. One, systemic sclerosis, is responsible for both pulmonary and esophageal manifestations, and it remains difficult to determine the role, if any, that each manifestation has in the pathogenesis of the other. Therapeutic trials are important in trying to determine this relationship. The other entity, IPF, has only recently been studied with esophageal pH
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Cited by (45)
Lung involvement in systemic sclerosis
2011, Presse MedicaleBoundaries of the lung - Relationship to the gastrointestinal system
2010, Revista Portuguesa de PneumologiaEsophageal involvement and interstitial lung disease in mixed connective tissue disease
2009, Respiratory MedicineCitation Excerpt :The pathologic mechanisms that trigger interstitial lung disease in MCTD remain unknown. More recently, gastroesophageal reflux and repeated microaspirations have been associated with interstitial lung disease in patients with systemic sclerosis.10–14 In patients with idiopathic pulmonary fibrosis, abnormal acid gastroesophageal reflux is very common, often clinically occult.
Esophageal Involvement in Scleroderma: Gastroesophageal Reflux, the Common Problem
2006, Seminars in Arthritis and RheumatismCitation Excerpt :A correlation was found between the degree of esophageal manometric motor disturbances and evidence of interstitial lung disease on pulmonary function tests and high-resolution computerized tomography in SSc patients, suggesting that GER may be one of the contributing factors for lung disease in SSc (42,67). A correlation but no causal relationship between GER and pulmonary fibrosis has been described (68), although this has not been confirmed in other studies (69). However, GER could enhance fibrosis in SSc patients (70).
Boundaries of the lung – Relationship to the gastrointestinal system
2010, Revista Portuguesa de Pneumologia (English Edition)