The Role of Gastroesophageal Reflux and Microaspiration in Idiopathic Pulmonary Fibrosis.

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.