Lee Joyce S
Department of Medicine, University of California, San Francisco.
Clin Pulm Med. 2014 Mar 1;21(2):81-85. doi: 10.1097/cpm.0000000000000031.
There has been controversy regarding the relationship between gastroesophageal reflux, microaspiration, and idiopathic pulmonary fibrosis (IPF). In the last decade, there is increasing evidence supporting a relationship between gastroesophageal reflux, microaspiration, and IPF. Specifically, gastroesophageal reflux is common in IPF, is often asymptomatic in this population, and may impact disease progression and the natural history of IPF. More intriguing are the data suggesting that treatment of gastroesophageal reflux, either medical or surgical, may slow disease progression, as measured by change in forced vital capacity, and improve survival in IPF. Despite the growing evidence, there are still many gaps in our understanding of this relationship. Some of the major gaps include the discrepancy between the prevalence of gastroesophageal reflux in the general population compared to the prevalence of IPF, the unclear causative agent leading to injury, the lack of reliable methods to evaluate for gastroesophageal reflux and microaspiration, and the role of treatment. Further research, including a randomized controlled trial of anti-reflux therapy, needs to be done to clarify the relationship between gastroesophageal reflux, microaspiration, and IPF.
关于胃食管反流、微量误吸与特发性肺纤维化（IPF）之间的关系一直存在争议。在过去十年中，越来越多的证据支持胃食管反流、微量误吸与IPF之间存在关联。具体而言，胃食管反流在IPF中很常见，在这一人群中通常无症状，且可能影响疾病进展和IPF的自然病程。更引人关注的是，有数据表明，无论是药物治疗还是手术治疗胃食管反流，都可能减缓疾病进展（通过用力肺活量的变化来衡量），并提高IPF患者的生存率。尽管证据越来越多，但我们对这种关系的理解仍存在许多空白。一些主要空白包括普通人群中胃食管反流的患病率与IPF的患病率之间的差异、导致损伤的致病因素不明、缺乏评估胃食管反流和微量误吸的可靠方法以及治疗的作用。需要开展进一步的研究，包括抗反流治疗的随机对照试验，以阐明胃食管反流、微量误吸与IPF之间的关系。
