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Protective Effect of Proton Pump Inhibitor for Survival in Patients with Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis.

Lee CM, Lee DH, Ahn BK, Hwang JJ, Yoon H, Shin CM, Park YS, Kim N - J Neurogastroenterol Motil (2016)

Bottom Line: Although some studies have suggested that proton pump inhibitors (PPI) were associated with a good prognosis in IPF, their effects remain unclear.In a univariate and multivariate Cox regression hazard model, younger age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.10; P = 0.001), higher initial forced vital capacity (HR, 0.98; 95% CI, 0.96-0.99; P = 0.004), and longer duration of PPI use (HR, 0.97; 95% CI, 0.95-1.00; P = 0.022), but not a diagnosis of GERD, were significantly associated with lower IPF-related mortality.PPI use for at least 4 months may have a protective effect against IPF-related mortality.

View Article: PubMed Central - PubMed

Affiliation: Divison of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.

ABSTRACT

Background/aims: The prevalence of gastroesophageal reflux disease (GERD) is high in patients with idiopathic pulmonary fibrosis (IPF). GERD may cause chronic microaspiration that leads to repeated subclinical lung injury, which leads to pulmonary fibrosis. Although some studies have suggested that proton pump inhibitors (PPI) were associated with a good prognosis in IPF, their effects remain unclear.

Methods: We retrospectively reviewed 786 consecutive adult patients with IPF at Seoul National University Bundang Hospital between April 2003 and March 2015.

Results: Mean duration of follow-up was 2.6 ± 2.8 years. Of the 786 patients with IPF, 107 (13.6%) were given diagnoses of GERD, and 103 (13.1%) died due to IPF-related pneumonia or respiratory failure. The prevalence of GERD and the cumulative incidence of de novo GERD increased depending on the period of follow-up in patients with IPF. Patients administered PPI for more than four months had a lower IPF-related mortality rate than patients on PPI less than 4 months (Log-rank P -value = 0.024 in Kaplan-Meier curve). In a univariate and multivariate Cox regression hazard model, younger age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.10; P = 0.001), higher initial forced vital capacity (HR, 0.98; 95% CI, 0.96-0.99; P = 0.004), and longer duration of PPI use (HR, 0.97; 95% CI, 0.95-1.00; P = 0.022), but not a diagnosis of GERD, were significantly associated with lower IPF-related mortality.

Conclusions: In Korean patients with IPF, the prevalence of GERD was lower than in other countries. PPI use for at least 4 months may have a protective effect against IPF-related mortality.

No MeSH data available.


Related in: MedlinePlus

The distribution of gastroesophageal reflux disease (GERD) according to classification. (A) The proportion of erosive reflux disease (ERD) and non-erosive reflux disease (NERD) in GERD patients with esophagogastroduodenoscopy (EGD) (n = 84). (B) The proportion of de novo GERD in patients with GERD (n = 107).
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f1-jnm-22-444: The distribution of gastroesophageal reflux disease (GERD) according to classification. (A) The proportion of erosive reflux disease (ERD) and non-erosive reflux disease (NERD) in GERD patients with esophagogastroduodenoscopy (EGD) (n = 84). (B) The proportion of de novo GERD in patients with GERD (n = 107).

Mentions: Of the 786 patients with IPF, GERD was diagnosed in 107 (13.6%). Of these 107, 84 (78.5%) underwent EGD for diagnosis of GERD, and 23 (21.5%) with typical symptoms were given diagnoses without EGD (Table 1). Of 84 patients who underwent EGD, the proportion with ERD was 18 (21.4%), and 66 (78.6%) had NERD (Fig. 1A). Of 679 IPF patients without GERD, 161 (23.7%) used PPI for treatment of peptic ulcer or diagnosis of GERD.


Protective Effect of Proton Pump Inhibitor for Survival in Patients with Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis.

Lee CM, Lee DH, Ahn BK, Hwang JJ, Yoon H, Shin CM, Park YS, Kim N - J Neurogastroenterol Motil (2016)

The distribution of gastroesophageal reflux disease (GERD) according to classification. (A) The proportion of erosive reflux disease (ERD) and non-erosive reflux disease (NERD) in GERD patients with esophagogastroduodenoscopy (EGD) (n = 84). (B) The proportion of de novo GERD in patients with GERD (n = 107).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4930299&req=5

f1-jnm-22-444: The distribution of gastroesophageal reflux disease (GERD) according to classification. (A) The proportion of erosive reflux disease (ERD) and non-erosive reflux disease (NERD) in GERD patients with esophagogastroduodenoscopy (EGD) (n = 84). (B) The proportion of de novo GERD in patients with GERD (n = 107).
Mentions: Of the 786 patients with IPF, GERD was diagnosed in 107 (13.6%). Of these 107, 84 (78.5%) underwent EGD for diagnosis of GERD, and 23 (21.5%) with typical symptoms were given diagnoses without EGD (Table 1). Of 84 patients who underwent EGD, the proportion with ERD was 18 (21.4%), and 66 (78.6%) had NERD (Fig. 1A). Of 679 IPF patients without GERD, 161 (23.7%) used PPI for treatment of peptic ulcer or diagnosis of GERD.

Bottom Line: Although some studies have suggested that proton pump inhibitors (PPI) were associated with a good prognosis in IPF, their effects remain unclear.In a univariate and multivariate Cox regression hazard model, younger age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.10; P = 0.001), higher initial forced vital capacity (HR, 0.98; 95% CI, 0.96-0.99; P = 0.004), and longer duration of PPI use (HR, 0.97; 95% CI, 0.95-1.00; P = 0.022), but not a diagnosis of GERD, were significantly associated with lower IPF-related mortality.PPI use for at least 4 months may have a protective effect against IPF-related mortality.

View Article: PubMed Central - PubMed

Affiliation: Divison of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.

ABSTRACT

Background/aims: The prevalence of gastroesophageal reflux disease (GERD) is high in patients with idiopathic pulmonary fibrosis (IPF). GERD may cause chronic microaspiration that leads to repeated subclinical lung injury, which leads to pulmonary fibrosis. Although some studies have suggested that proton pump inhibitors (PPI) were associated with a good prognosis in IPF, their effects remain unclear.

Methods: We retrospectively reviewed 786 consecutive adult patients with IPF at Seoul National University Bundang Hospital between April 2003 and March 2015.

Results: Mean duration of follow-up was 2.6 ± 2.8 years. Of the 786 patients with IPF, 107 (13.6%) were given diagnoses of GERD, and 103 (13.1%) died due to IPF-related pneumonia or respiratory failure. The prevalence of GERD and the cumulative incidence of de novo GERD increased depending on the period of follow-up in patients with IPF. Patients administered PPI for more than four months had a lower IPF-related mortality rate than patients on PPI less than 4 months (Log-rank P -value = 0.024 in Kaplan-Meier curve). In a univariate and multivariate Cox regression hazard model, younger age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.10; P = 0.001), higher initial forced vital capacity (HR, 0.98; 95% CI, 0.96-0.99; P = 0.004), and longer duration of PPI use (HR, 0.97; 95% CI, 0.95-1.00; P = 0.022), but not a diagnosis of GERD, were significantly associated with lower IPF-related mortality.

Conclusions: In Korean patients with IPF, the prevalence of GERD was lower than in other countries. PPI use for at least 4 months may have a protective effect against IPF-related mortality.

No MeSH data available.


Related in: MedlinePlus