• Home
  • About Us

Idiopathic Pulmonary Fibrosis

Jeremy Feldman, MD

  • What is Idiopathic Pulmonary Fibrosis?
    • Idiopathic Pulmonary Fibrosis Definition
    • Symptoms of Idiopathic Pulmonary Fibrosis
    • Causes of Idiopathic Pulmonary Fibrosis
    • Who Gets Idiopathic Pulmonary Fibrosis
    • Gastro-Esophageal Reflux (GER) and Idiopathic Pulmonary Fibrosis
    • Interstitial Lung Disease vs. Idiopathic Pulmonary Fibrosis
    • Is Pulmonary Fibrosis Hereditary?
    • Research, Life Expectancy and Prognosis for Idiopathic Pulmonary Fibrosis
  • Diagnosing & Monitoring PF
    • Monitoring Progress of IPF
    • Idiopathic Pulmonary Fibrosis Diagnosis
    • Chest X-rays Used in IPF
    • CPET used in IPF
    • HRCT Scans Used to Evaluate IPF
    • Lung Biopsy To Diagnose IPF
    • Pulmonary Function Tests (PFTS)
    • Six Minute Walk Test To Monitor IPF
    • Stages of Idiopathic Pulmonary Fibrosis
    • Complications of Idiopathic Pulmonary Fibrosis
  • PF Treatment Options
    • Esbriet (pirfenidone) Used to Treat IPF
    • OFEV (nintedanib) Used to Treat IPF
    • Pulmonary Rehab for IPF Patients
    • Lung Transplantation for Pulmonary Fibrosis
    • Oxygen Used to Treat IPF
      • Update on Oxygen Use
    • Clinical Trials in Idiopathic Pulmonary Fibrosis
    • IPF & Leg Swelling
    • Pulmonary Hypertension and Idiopathic Pulmonary Fibrosis
    • IPF Exacerbation
  • PF Advocacy & News
  • FAQ’s
    • Respiratory failure, NSIP, diet
    • Leg swelling, lung biopsy, side effects & pets
    • FAQ’s Enzyme Therapy, Progression of IPF & Oxygen
    • FAQ: Diarrhea, Fibrosis Reversal, IPF Symptoms
    • FAQ: Oxygen Flow, Anesthesia & Genetics
    • FAQ: Contagious Cough? Stem Cells, Familial IPF, Flying
    • FAQ: GERD, Fatigue & Environmental Exposure
    • FAQ: How to Travel to Your Doctor’s Office with Oxygen
    • FAQ: Lung Biopsy with Pulmonary Fibrosis
    • FAQ’s: Alcohol, Clinical Trials, Pulmonary Function Testing
    • FAQs: Emphysema, Exercise & Lung Biopsy

Gastro-Esophageal Reflux and IPF: Which Came First, the Chicken or the Egg?

August 17, 2016 By Dr. Jeremy Feldman

GER may contribute to IPFWe have mentioned that GERD is an important concern for patients with IPF.  We have ample data showing that patients with IPF are at greatly increased risk of having either symptomatic or silent (without any symptoms) GERD and even aspiration of small amounts of stomach contents into the lungs.  However, what remains unclear is how this should impact patient care.  We don’t have compelling data that proves that GERD causes IPF and we have no high quality data that treating GERD improves patient outcomes.

The most widely held belief is that GERD leads to silent micro-aspiration (unnoticed inhaling of stomach contents) and patients with IPF for unclear reasons have an exaggerated response that leads to or propels their IPF forward.  Data supporting this position comes from studies showing that the vast majority of patients with IPF when studied carefully have acidic stomach contents that reflux into their esophagus.  Furthermore, IPF patients with GERD have a more rapid decline in lung function.

Another group of experts is less convinced that GERD is the engine that drives IPF forward and believes that IPF leads to GERD.  Patients with IPF have stiff lungs.  This results in more negative pressures inside their chest.  This negative pressure may act to draw stomach contents into the esophagus thereby causing GERD.  In this theory, patients with more advanced disease or stiffer lungs are more likely to have more GERD and more rapidly declining lung function.

Recent studies have raised concern about the risks of long-term proton pump inhibitors (omeprazole/Prilosec and the many related compounds).  Studies have shown an association between extended treatment with proton pump inhibitors and bone loss (osteoporosis), and kidney failure.

My take on this complicated and important issue is that I believe that IPF is a progressive and difficult to treat disease.  At this point in time, the balance of the data supports at least some role for GERD in IPF.  Our current treatment options are limited and less than ideal.  The risks of acid suppression though real are very small in the 5-year timeframe and can be reduced by taking supplemental magnesium.  It is naïve to think that taking an omeprazole pill once or twice a day will cure gastro-esophageal reflux.  At best acid suppression removes the acid (raises the pH of stomach contents).  I strongly encourage my patients to elevate the head of their bed and avoid foods known to promote gastro-esophageal reflux such as alcohol, caffeine, citrus, fatty foods, spicy foods, large meals and late meals.

Filed Under: IPF Tips

Featured Blog Posts

woman sick infection

Respiratory Viruses and IPF

Discussion about IPF

How is My Pulmonary Fibrosis Doing?

IPF cough

FAQ: Contagious Cough? Stem Cells, Familial IPF, Flying

Recent Posts

  • Interstitial Lung Disease and Progressive Pulmonary Fibrosis
  • Pamrevlumab Ineffective in Treating IPF
  • New Drugs Moving Forward for IPF

Search by Keyword (Examples: GERD, Coughing, Traveling, etc.)

Search by Category

Popular Articles

IPF patient with doctor

Idiopathic Pulmonary Fibrosis Treatment Options

What is IPF?

  • What is Idiopathic Pulmonary Fibrosis?
    • Symptoms of Idiopathic Pulmonary Fibrosis
    • Causes of Idiopathic Pulmonary Fibrosis
    • Who Gets Idiopathic Pulmonary Fibrosis
    • Gastro-Esophageal Reflux (GER) and IPF
    • Interstitial Lung Disease vs. Idiopathic Pulmonary Fibrosis
    • Is Pulmonary Fibrosis Hereditary?
    • Research, Life Expectancy & Prognosis for Pulmonary Fibrosis

Diagnosing IPF

  • Idiopathic Pulmonary Fibrosis Diagnosis
    • Chest X-rays Used in IPF
    • CPET used in IPF
    • HRCT Scans Used to Evaluate IPF
    • Lung Biopsy To Diagnose IPF
    • Pulmonary Function Tests (PFTS)
    • Six Minute Walk Test To Monitor IPF
    • Stages of Idiopathic Pulmonary Fibrosis
    • Complications of Idiopathic Pulmonary Fibrosis

Treating IPF

  • Pulmonary Fibrosis Treatment Options
    • Esbriet (pirfenidone) Used to Treat IPF
    • OFEV (nintedanib) Used to Treat IPF
    • Pulmonary Rehab for IPF Patients
    • Lung Transplantation for Pulmonary Fibrosis
    • Oxygen Used to Treat IPF
    • Clinical Trials in Idiopathic Pulmonary Fibrosis
    • IPF & Leg Swelling
    • Pulmonary Hypertension and Idiopathic Pulmonary Fibrosis
    • IPF Exacerbation

Disclaimer