High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis
High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis
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DOI：
10.1183/09031936.06.00037005
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发表时间：
2006-01-01
影响因子：
24.3
通讯作者：
Pellegrini, CA
中科院分区：
文献类型：
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作者：
Raghu, G;Freudenberger, TD;Pellegrini, CA
这项前瞻性研究的目的是确定特发性肺纤维化（IPF）患者胃酸-食管反流（GER）的患病率和特征。连续65例明确IPF的患者接受24小时pH监测和食管压力测量。共133例连续出现难治性哮喘和GER症状的患者作为对照。IPF患者中异常酸性GER的患病率为87%，其中76%和63%分别表现为食管远端和近端酸暴露异常。IPF患者酸性GER异常明显多于哮喘患者。只有47%的IPF患者出现了典型的GER症状。尽管使用标准剂量的质子泵抑制剂（PPIs）治疗，但在24小时pH监测期间接受PPIs治疗的19例患者中，有12例的pH探头显示食管酸暴露异常。IPF严重程度与酸性GER严重程度无相关性。总之，异常的胃酸-食管反流是非常普遍的，但在特发性肺纤维化患者中往往是临床隐匿的。标准剂量的质子泵抑制剂可能不能抑制这一人群的胃酸-食管反流。因此，需要进一步的研究来确定酸性异常胃食管反流是否是特发性肺纤维化发生或进展的重要危险因素，以及最佳抑制酸性胃食管反流是否减缓特发性肺纤维化的进展和/或减少特发性肺纤维化的发作性加重。
The aim of this prospective study was to determine the prevalence and characteristics of acid gastro-oesophageal reflux (GER) in patients with idiopathic pulmonary fibrosis (IPF).Sixty-five consecutive patients with well-defined IPF were subjected to 24-h pH monitoring and oesophageal manometry. A total of 133 consecutive patients with intractable asthma and symptoms of GER were used as comparisons.The prevalence of abnormal acid GER in IPF patients was 87%, with 76% and 63% demonstrating abnormal distal and proximal oesophageal acid exposures, respectively. Abnormal acid GER was significantly more common in IPF patients than asthma patients. Only 47% of IPF patients experienced classic GER symptoms. Despite treatment with standard doses of proton pump inhibitors (PPIs), 12 out of 19 patients receiving PPIs during the 24-h pH monitoring had abnormal oesophageal acid exposures by pH probe. There was no correlation between IPF severity and acid GER severity.In conclusion, abnormal acid gastro-oesophageal reflux is highly prevalent, but often clinically occult in patients with idiopathic pulmonary fibrosis. Standard doses of proton pump inhibitors may not suppress the acid gastro-oesophageal reflux in this population. Therefore, further studies are needed to determine if acid abnormal gastro-oesophageal reflux represents an important risk factor for idiopathic pulmonary fibrosis development or progression, and if optimal suppression of acid gastro-oesophageal reflux slows the progression of idiopathic pulmonary fibrosis and/or decreases episodic exacerbations of idiopathic pulmonary fibrosis.