Reflux in idiopathic pulmonary fibrosis

Key points Gastro-oesophageal reflux disease (GORD) was first implicated in the pathogenesis of pulmonary fibrosis in 1976.1 Idiopathic Pulmonary Fibrosis presents most commonly in the six decade of life and has a dismal median survival of 2–3 years. There have been significant and encouraging increases in knowledge underpinning key mechanisms of pathogenesis in terms of angiogenesis, signaling pathways, pro-fibrotic cell types and early remodelling.2–4 Currently, the initiating events remains unknown however many possibilities have been identified. Despite the increased understanding of pathogenesis anti-inflammatory and target specific strategies, with the exception of Pirfenidone and Nintedanib, have been ineffective in terms of survival. An area generating heightened interest is modification of preventative risk factors that may drive more aggressive disease. In recent times micro-aspiration as a result of reflux has been receiving renewed interest. Partially because of its prevalence in idiopathic pulmonary fibrosis (IPF) but also recent data suggest survival benefit in those on anti-secretory medication. We will review the current evidence with regards to association, treatment and impact on the natural history of IPF. We suggest that current evidence leads weight to the concept of GORD as a potential driver of disease progression and responsible for acute exacerbations (AEs) in a subgroup of patients therefore treatment with anti-reflux medications may form the basis of a lung protective strategy. GORD has been implicated in the pathogenesis of pulmonary fibrosis for almost half a century. Early studies in IPF patients awaiting transplantation found the prevalence of reflux to be around 60%. …