Gastroesophageal reflux disease may contribute to development of lung fibrosis

In a new study, the odds of having gastroesophageal reflux disease were nearly two times higher in patients with idiopathic pulmonary fibrosis compared with adults without idiopathic pulmonary fibrosis.

“This risk of GERD appeared greater in patients with non-IPF [interstitial lung disease] when compared with patients with IPF, a finding previously unreported in population-based studies,” Misbah Baqir, MBBS, critical care specialist and pulmonologist in the division of pulmonary and critical care medicine at Mayo Clinic in Rochester, New York, and colleagues wrote in Respiratory Medicine.

Researchers evaluated medical records from the Rochester Epidemiology Project and identified 113 patients with IPF (mean age, 74 years; 60.2% men) living in Olmsted County, Minnesota, from 1997 to June 2017. Cases of IPF were matched with 226 non-IPF ILD controls and 226 population controls to assess associations between GERD diagnosis and IPF status.

Compared with non-IPF ILD controls, patients with IPF had significantly lower predicted FVC (75% vs. 80%), lower predicted diffusing capacity for carbon monoxide (DLCO; 53% vs. 60%) and lower omeprazole use (11.5% vs. 25.2%). Patients with IPF were more likely to have a GERD diagnosis (43.4% vs. 28.5%) and were more likely to be current smokers (15.9% vs. 3.6%) compared with controls.

The odds of GERD diagnosis were 1.78 (95% CI, 1.09-2.91; P = .02) times higher among patients with IPF compared with patients in the population control group after multivariable adjustment. In addition, IPF remained significantly associated with smoking status in former smokers (OR = 1.85; 95% CI, 1.1-3.12; P < .001) and current smokers (OR = 6.81; 95% CI, 2.59-17.93; P < .001).

The odds of GERD diagnosis were 0.46 (95% CI, 0.23-0.94; P = .03) times lower among patients with IPF compared with patients in the non-IPF ILD control group.

In univariate comparisons, patients with IPF had 1.89 (95% CI, 1.18-3.01; P = .008) times higher odds of GERD diagnosis compared with patients in the population control group.

“Further study is needed to ascertain the possibility of increased risk for GERD in patients with non-IPF ILD because GERD may be an important contributor to the development of lung fibrosis,” the researchers wrote. “Thus, it should be investigated and addressed adequately when detected in any patient with pulmonary fibrosis.”