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Gastroesophageal reflux and antacid therapy in IPF: analysis from the Australia IPF Registry


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Jo, HE, Corte, TJ, Glaspole, I, Grainge, C, Hopkins, PMA, Moodley, Y, Reynolds, PN, Chapman, S, Walters, EH ORCID: 0000-0002-0993-4374, Zappala, C, Allan, H, Keir, GJ, Cooper, WA, Mahar, AM, Ellis, S, MacAnsh, S and Goh, NS 2019 , 'Gastroesophageal reflux and antacid therapy in IPF: analysis from the Australia IPF Registry' , BMC Pulmonary Medicine, vol. 19, no. 1 , p. 84 , doi: 10.1186/s12890-019-0846-2.

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Background and objective:Gastroesophageal reflux disease (GORD) is highly prevalent in idiopathic pulmonary fibrosis (IPF) and may play a role in its pathogenesis. Recent IPF treatment guidelines suggest that all patients with IPF be considered for antacid therapy. However, emerging evidence suggests that antacid therapy does not improve IPF patient outcomes and may increase the risk of pulmonary infection.Methods:Using prospectively collected data from the Australian IPF Registry including use of antacid therapy, GORD diagnosis and GORD symptoms, the relationship of these GORD variables to survival and disease progression was assessed. The severity of GORD symptoms using the frequency scale for symptoms of GORD (FSSG) and its relationships to outcomes was also assessed for the first time in an IPF cohort.Results:Five hundred eighty-seven (86%) of the 684 patients in the Australian IPF Registry were eligible for inclusion. Patients were mostly male (69%), aged 71.0 ± 8.5 years with moderate disease (FVC 81.7 ± 21.5%; DLco 48.5 ± 16.4%). Most patients were taking antacids (n = 384; 65%), though fewer had a diagnosis of GORD (n = 243, 41.4%) and typical GORD symptoms were even less common (n = 171, 29.1%). The mean FSSG score was 8.39 ± 7.45 with 43% (n = 251) having a score > 8. Overall, there was no difference in survival or disease progression, regardless of antacid treatment, GORD diagnosis or GORD symptoms.Conclusions:Neither the use of antacid therapy nor the presence of GORD symptoms affects longer term outcomes in IPF patients. This contributes to the increasing evidence that antacid therapy may not be beneficial in IPF patients and that GORD directed therapy should be considered on an individual basis to treat the symptoms of reflux.

Item Type: Article
Authors/Creators:Jo, HE and Corte, TJ and Glaspole, I and Grainge, C and Hopkins, PMA and Moodley, Y and Reynolds, PN and Chapman, S and Walters, EH and Zappala, C and Allan, H and Keir, GJ and Cooper, WA and Mahar, AM and Ellis, S and MacAnsh, S and Goh, NS
Keywords: idiopathic pulmonary fibrosis, gastroesophageal reflux disease, antacid, registry, cough
Journal or Publication Title: BMC Pulmonary Medicine
Publisher: BioMed Central Ltd.
ISSN: 1471-2466
DOI / ID Number: 10.1186/s12890-019-0846-2
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Copyright 2019 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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