Idiopathic pulmonary fibrosis and gastroesophageal reflux disease (GERD)

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibroinflammatory lung disease associated with increased morbidity and mortality. As its name suggests, the exact cause of the disease is not known.

However, some genetic and environmental factors have been observed concurrently with the condition and are considered potential etiologic factors, although causal relationships have not been established. Gastroesophageal reflux disease (GERD) is one such factor.

The objective of this study was to determine whether patients with IPF were more likely to have GERD compared with age- and sex-matched controls that either had 1) interstitial lung disease (ILD) other than IPF or 2) no diagnosed lung disease (population control).

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IPF patients had almost double the risk of having GERD compared with patients with no lung disease.

The odds of GERD before a diagnosis of interstitial lung disease appeared greater in patients with non-IPF ILD than IPF.

This case-control study showed that patients with IPF had a nearly 2-fold increased risk of having GERD compared with population controls.

Thus, it should be investigated and addressed adequately when detected in any patient with pulmonary fibrosis.

GERD may be an important contributor to the development of lung fibrosis.

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Abstract

Background

It is unknown whether gastroesophageal reflux disease (GERD) is a risk factor or consequence of idiopathic pulmonary fibrosis (IPF). This study aimed to determine whether patients with IPF were more likely to have GERD compared with age- and sex-matched controls who either had 1) interstitial lung disease (ILD) other than IPF or 2) no diagnosed lung disease (population control).

Methods

We used the medical records-linkage system of the Rochester Epidemiology Project (REP) to identify patients with IPF who resided in Olmsted County, Minnesota, from January 1, 1997, through June 30, 2017. IPF cases were each matched with patients from 2 control groups (non-IPF ILD controls and population controls). We used conditional logistic regression to model associations between GERD diagnosis and IPF case status. P values were adjusted for multiple comparisons by using the Bonferroni adjustment.

Results

One hundred thirteen IPF cases were identified and matched to 226 population controls and 226 controls with non-IPF ILD. After multivariable adjustment, the odds of having GERD were 1.78 times higher in IPF cases compared with population controls. After multivariable adjustment, the odds of having GERD were 0.46 times lower in IPF cases compared with non-IPF ILD controls.

Conclusion

GERD may be an important contributor to the development of lung fibrosis. Thus, it should be investigated and addressed adequately when detected in patients with IPF and patients with non-IPF ILD.