Center for Esophageal Diseases.
Advanced Lung Disease Specialists, Baylor University Medical Center, Dallas, Texas, USA.
Curr Opin Gastroenterol. 2022 Jul 1;38(4):411-416. doi: 10.1097/MOG.0000000000000841.
Idiopathic pulmonary fibrosis (IPF) is a prevalent subset of interstitial lung disease (ILD) that often progresses to require lung transplantation. Gastroesophageal reflux disease (GERD) is common in the IPF population, and GER-related micro-aspiration appears to be an important risk factor for IPF pathogenesis and for the deterioration of transplanted lung function.
Many patients with IPF have elevated esophageal acid exposure on reflux testing despite having no or minimal symptoms. Studies on the effects of medical GERD therapy on IPF-related outcomes have had mixed results. Antireflux surgery is safe in appropriately selected IPF patients, and appears to have potential for slowing the decline of lung function. GERD can persist, improve or develop after lung transplantation, and the presence of GERD is associated with allograft injury and pulmonary function decline in lung transplant recipients.
Clinicians should have a low threshold to assess for objective evidence of GERD in IPF patients. Antireflux surgery in IPF patients with GERD appears to improve lung function, but further studies are needed before surgical treatment can be recommended routinely in this setting. In lung transplant recipients, reflux testing after transplant is the most accurate way to guide GERD treatment decisions.
特发性肺纤维化（IPF）是一种常见的间质性肺疾病（ILD），常进展为需要进行肺移植。胃食管反流病（GERD）在 IPF 人群中很常见，GER 相关的微量误吸似乎是 IPF 发病机制和移植后肺功能恶化的一个重要危险因素。
尽管 IPF 患者没有或仅有轻微的症状，但在反流测试中，许多患者的食管酸暴露水平升高。关于 GERD 治疗对 IPF 相关结局影响的研究结果喜忧参半。抗反流手术在适当选择的 IPF 患者中是安全的，并且似乎有潜力减缓肺功能下降。GERD 可在肺移植后持续存在、改善或发生，GERD 的存在与移植物损伤和肺移植受者的肺功能下降有关。
临床医生应该对 IPF 患者进行 GERD 的客观证据评估。对于有 GERD 的 IPF 患者，抗反流手术似乎可以改善肺功能，但在该治疗方案常规应用于该人群之前，还需要更多的研究。在肺移植受者中，移植后进行反流测试是指导 GERD 治疗决策的最准确方法。
