Interstitial lung disease and gastroesophageal reflux

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Abstract

Gastroesophageal reflux (GER) has been associated with a number of interstitial lung diseases, including systemic sclerosis and idiopathic pulmonary fibrosis. Systemic sclerosis results in both pulmonary and esophageal manifestations, and studies have shown a correlation, but no causal relation, between GER and pulmonary fibrosis in this condition. The role of GER in idiopathic pulmonary fibrosis has recently been studied using esophageal pH monitoring, and the results show high prevalence of GER compared with normal individuals and patients with other interstitial lung diseases of known cause. Aggressive, long-term therapy of GER and evaluation of its effect on pulmonary disease will allow determination of the real influence of GER on idiopathic pulmonary fibrosis. Additional outcomes-based studies and therapeutic trials are needed to clarify the association between GER and interstitial lung diseases.

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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