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Relationship Between Esophageal Disease and Pulmonary Fibrosis

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Abstract

Esophageal disorders are prevalent among patients with chronic lung diseases, including idiopathic pulmonary fibrosis (IPF). Gastroesophageal reflux disease (GERD) has been associated with IPF prevalence, severity, and respiratory decline. The pathophysiologic relationship between GERD and IPF is likely bidirectional, with aspiration of refluxate leading to lung inflammation and fibrosis, while the restrictive pulmonary physiology may contribute to altered transdiaphragmatic pressure gradient and increased reflux. Esophageal symptoms are frequently absent and do not predict esophageal dysfunction or pathologic reflux in patients with IPF, and objective diagnostic tools including upper endoscopy, ambulatory reflux monitoring, and high-resolution manometry are often needed. Impedance-based testing that identifies both weakly/non-acidic and acid reflux may provide important additional diagnostic value beyond pH-based acid testing alone. Novel metrics and maneuvers, including advanced impedance measures on impedance-pH study and provocative testing on HRM, may hold promise to future diagnostic advancements. The main treatment options include medical therapy with acid suppressants and anti-reflux surgery, although their potential benefits in pulmonary outcomes of IPF require further validations. Future directions of research include identifying phenotypes of IPF patients who may benefit from esophageal testing and treatment, determining the optimal testing strategy and protocol, and prospectively assessing the value of different esophageal therapies to improve outcomes while minimizing risks. This review will discuss the pathophysiology, evaluation, and management of esophageal diseases, particularly GERD, in patients with IPF, as informed by the most recent publications in the field, in hopes of identifying targets for future study and research.

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References

  1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871–880. https://doi.org/10.1136/gutjnl-2012-304269.

    Article  PubMed  Google Scholar 

  2. Shaheen NJ, Hansen RA, Morgan DR et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol. 2006;101(9):2128–2138. https://doi.org/10.1111/j.1572-0241.2006.00723.x.

    Article  PubMed  Google Scholar 

  3. Sontag SJ, O’Connell S, Khandelwal S et al. Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. Gastroenterology. 1990;99(3):613–620. https://doi.org/10.1016/0016-5085(90)90945-w.

    Article  CAS  PubMed  Google Scholar 

  4. Broers C, Tack J, Pauwels A. Review article: gastro-oesophageal reflux disease in asthma and chronic obstructive pulmonary disease. Aliment Pharmacol Ther. 2018;47(2):176–191. https://doi.org/10.1111/apt.14416.

    Article  CAS  PubMed  Google Scholar 

  5. Ing AJ. Interstitial lung disease and gastroesophageal reflux. Am J Med. 2001;111(Suppl 8A):41S-44S. https://doi.org/10.1016/s0002-9343(01)00847-6.

    Article  PubMed  Google Scholar 

  6. el-Serag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology 1997;113(3):755–60. https://doi.org/10.1016/s0016-5085(97)70168-9.

    Article  CAS  PubMed  Google Scholar 

  7. Baqir M, Vasirreddy A, Vu AN et al. Idiopathic pulmonary fibrosis and gastroesophageal reflux disease: a population-based, case-control study. Respir Med. 2021;178:106309. https://doi.org/10.1016/j.rmed.2021.106309.

    Article  PubMed  PubMed Central  Google Scholar 

  8. D’Ovidio F, Singer LG, Hadjiliadis D et al. Prevalence of gastroesophageal reflux in end-stage lung disease candidates for lung transplant. Ann Thorac Surg. 2005;80(4):1254–1260. https://doi.org/10.1016/j.athoracsur.2005.03.106.

    Article  PubMed  Google Scholar 

  9. Gribbin J, Hubbard R, Smith C. Role of diabetes mellitus and gastro-oesophageal reflux in the aetiology of idiopathic pulmonary fibrosis. Respir Med. 2009;103(6):927–931. https://doi.org/10.1016/j.rmed.2008.11.001.

    Article  PubMed  Google Scholar 

  10. Confalonieri P, Volpe MC, Jacob J et al. Regeneration or repair? The role of alveolar epithelial cells in the pathogenesis of idiopathic pulmonary fibrosis (IPF). Cells. 2022;11(13):2095. https://doi.org/10.3390/cells11132095.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Raghu G, Collard HR, Egan JJ et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788–824. https://doi.org/10.1164/rccm.2009-040GL.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tobin RW, Pope CE 2nd, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158(6):1804–1808. https://doi.org/10.1164/ajrccm.158.6.9804105.

    Article  CAS  PubMed  Google Scholar 

  13. Okwara NC, Chan WW. Sorting out the relationship between esophageal and pulmonary disease. Gastroenterol Clin North Am. 2021;50(4):919–934. https://doi.org/10.1016/j.gtc.2021.08.006.

    Article  PubMed  Google Scholar 

  14. Savarino E, Carbone R, Marabotto E et al. Gastro-oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients. Eur Respir J. 2013;42(5):1322–1331. https://doi.org/10.1183/09031936.00101212.

    Article  PubMed  Google Scholar 

  15. Perng DW, Chang KT, Su KC et al. Exposure of airway epithelium to bile acids associated with gastroesophageal reflux symptoms: a relation to transforming growth factor-beta1 production and fibroblast proliferation. Chest. 2007;132(5):1548–1556. https://doi.org/10.1378/chest.07-1373.

    Article  CAS  PubMed  Google Scholar 

  16. Appel JZ 3rd, Lee SM, Hartwig MG et al. Characterization of the innate immune response to chronic aspiration in a novel rodent model. Respir Res. 2007;8:87. https://doi.org/10.1186/1465-9921-8-87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Salgado S, Borges LF, Cai JX, Lo WK, Carroll TL, Chan WW. Symptoms classically attributed to laryngopharyngeal reflux correlate poorly with pharyngeal reflux events on multichannel intraluminal impedance testing. Dis Esophagus. 2022. https://doi.org/10.1093/dote/doac041.

    Article  PubMed  Google Scholar 

  18. Posner S, Zheng J, Wood RK et al. Gastroesophageal reflux symptoms are not sufficient to guide esophageal function testing in lung transplant candidates. Dis Esophagus. 2018. https://doi.org/10.1093/dote/dox157.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bredenoord AJ, Weusten BL, Smout AJ. Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut. 2005;54(12):1810–1817. https://doi.org/10.1136/gut.2005.072629.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Savarino E, Marabotto E, Bodini G et al. Advancements in the use of manometry and impedance testing for esophageal functional disorders. Expert Rev Gastroenterol Hepatol. 2019;13(5):425–435. https://doi.org/10.1080/17474124.2019.1595587.

    Article  CAS  PubMed  Google Scholar 

  21. Gyawali CP, Kahrilas PJ, Savarino E et al. Modern diagnosis of GERD: the Lyon consensus. Gut. 2018;67(7):1351–1362. https://doi.org/10.1136/gutjnl-2017-314722.

    Article  PubMed  Google Scholar 

  22. Lo WK, Burakoff R, Goldberg HJ, Feldman N, Chan WW. Pre-transplant impedance measures of reflux are associated with early allograft injury after lung transplantation. J Heart Lung Transplant. 2015;34(1):26–35. https://doi.org/10.1016/j.healun.2014.09.005.

    Article  PubMed  Google Scholar 

  23. Gavini S, Borges LF, Finn RT et al. Lung disease severity in idiopathic pulmonary fibrosis is more strongly associated with impedance measures of bolus reflux than pH parameters of acid reflux alone. Neurogastroenterol Motil. 2017;29(5):13001. https://doi.org/10.1111/nmo.13001.

    Article  CAS  Google Scholar 

  24. Borges LF, Chan WW, Carroll TL. Dual pH probes without proximal esophageal and pharyngeal impedance may be deficient in diagnosing LPR. J Voice. 2019;33(5):697–703. https://doi.org/10.1016/j.jvoice.2018.03.008.

    Article  PubMed  Google Scholar 

  25. Zhong C, Duan L, Wang K et al. Esophageal intraluminal baseline impedance is associated with severity of acid reflux and epithelial structural abnormalities in patients with gastroesophageal reflux disease. J Gastroenterol. 2013;48(5):601–610. https://doi.org/10.1007/s00535-012-0689-6.

    Article  CAS  PubMed  Google Scholar 

  26. Frazzoni M, Savarino E, de Bortoli N et al. Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol. 2016;14(1):40–46. https://doi.org/10.1016/j.cgh.2015.06.026.

    Article  PubMed  Google Scholar 

  27. Patel A, Wang D, Sainani N, Sayuk GS, Gyawali CP. Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2016;44(8):890–898. https://doi.org/10.1111/apt.13777.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Frazzoni M, de Bortoli N, Frazzoni L et al. The added diagnostic value of postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on-therapy impedance-pH monitoring. Neurogastroenterol Motil. 2017. https://doi.org/10.1111/nmo.12947.

    Article  PubMed  Google Scholar 

  29. Yadlapati R, Kahrilas PJ, Fox MR et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0((c)). Neurogastroenterol Motil. 2021;33(1):e14058. https://doi.org/10.1111/nmo.14058.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Fornari F, Bravi I, Penagini R, Tack J, Sifrim D. Multiple rapid swallowing: a complementary test during standard oesophageal manometry. Neurogastroenterol Motil. 2009;21(7):718-e41. https://doi.org/10.1111/j.1365-2982.2009.01273.x.

    Article  CAS  PubMed  Google Scholar 

  31. Carlson DA, Roman S. Esophageal provocation tests: are they useful to improve diagnostic yield of high resolution manometry? Neurogastroenterol Motil. 2018;30(4):e13321. https://doi.org/10.1111/nmo.13321.

    Article  CAS  PubMed  Google Scholar 

  32. Marin I, Serra J. Patterns of esophageal pressure responses to a rapid drink challenge test in patients with esophageal motility disorders. Neurogastroenterol Motil. 2016;28(4):543–53. https://doi.org/10.1111/nmo.12749.

    Article  CAS  PubMed  Google Scholar 

  33. Raghu G, Freudenberger TD, Yang S et al. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J. 2006;27(1):136–42. https://doi.org/10.1183/09031936.06.00037005.

    Article  CAS  PubMed  Google Scholar 

  34. Soares RV, Forsythe A, Hogarth K, Sweiss NJ, Noth I, Patti MG. Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment. Arq Gastroenterol. Apr-Jun 2011;48(2):91–7. https://doi.org/10.1590/s0004-28032011000200002.

    Article  Google Scholar 

  35. Rangan V, Borges LF, Lo WK et al. Novel advanced impedance metrics on impedance-pH testing predict lung function decline in idiopathic pulmonary fibrosis. Am J Gastroenterol. 2022;117(3):405–412. https://doi.org/10.14309/ajg.0000000000001577.

    Article  PubMed  Google Scholar 

  36. Gavini S, Finn RT, Lo WK et al. Idiopathic pulmonary fibrosis is associated with increased impedance measures of reflux compared to non-fibrotic disease among pre-lung transplant patients. Neurogastroenterol Motil. 2015;27(9):1326–32. https://doi.org/10.1111/nmo.12627.

    Article  CAS  PubMed  Google Scholar 

  37. Borges LF, Jagadeesan V, Goldberg H et al. Abnormal bolus reflux is associated with poor pulmonary outcome in patients with idiopathic pulmonary fibrosis. J Neurogastroenterol Motil. 2018;24(3):395–402. https://doi.org/10.5056/jnm18023.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lo WK, Goldberg HJ, Burakoff R, Feldman N, Chan WW. Increased proximal acid reflux is associated with early readmission following lung transplantation. Neurogastroenterol Motil. 2016;28(2):251–9. https://doi.org/10.1111/nmo.12720.

    Article  CAS  PubMed  Google Scholar 

  39. Lo WK, Burakoff R, Goldberg HJ, Feldman N, Chan WW. Pre-lung transplant measures of reflux on impedance are superior to pH testing alone in predicting early allograft injury. World J Gastroenterol. 2015;21(30):9111–7. https://doi.org/10.3748/wjg.v21.i30.9111.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lo WK, Moniodis A, Goldberg HJ, Feldman N, Chan WW. Increased acid exposure on pretransplant impedance-pH testing is associated with chronic rejection after lung transplantation. J Clin Gastroenterol. 2020. https://doi.org/10.1097/MCG.0000000000001331.

    Article  PubMed  Google Scholar 

  41. Sikavi DR, Cai JX, Carroll TL, Chan WW. Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol. 2021;36(8):2076–2082. https://doi.org/10.1111/jgh.15391.

    Article  PubMed  Google Scholar 

  42. Cheah R, Chirnaksorn S, Abdelrahim AH et al. The perils and pitfalls of esophageal dysmotility in idiopathic pulmonary fibrosis. Am J Gastroenterol. 2021;116(6):1189–1200. https://doi.org/10.14309/ajg.0000000000001202.

    Article  PubMed  Google Scholar 

  43. Shetler KP, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30(6):1–8. https://doi.org/10.1093/dote/dox012.

    Article  CAS  PubMed  Google Scholar 

  44. Mittal R, Vaezi MF. Esophageal motility disorders and gastroesophageal reflux disease. N Engl J Med. 2020;383(20):1961–1972. https://doi.org/10.1056/NEJMra2000328.

    Article  CAS  PubMed  Google Scholar 

  45. Gao F, Hobson AR, Shang ZM et al. The prevalence of gastro-esophageal reflux disease and esophageal dysmotility in Chinese patients with idiopathic pulmonary fibrosis. BMC Gastroenterol. 2015;15:26. https://doi.org/10.1186/s12876-015-0253-y.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sikavi DR, Cai JX, Leung R, Carroll TL, Chan WW. Impaired proximal esophageal contractility predicts pharyngeal reflux in patients with laryngopharyngeal reflux symptoms. Clin Transl Gastroenterol. 2021;12(10):e00408. https://doi.org/10.14309/ctg.0000000000000408.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Babaei A, Venu M, Naini SR et al. Impaired upper esophageal sphincter reflexes in patients with supraesophageal reflux disease. Gastroenterology. 2015;149(6):1381–91. https://doi.org/10.1053/j.gastro.2015.07.007.

    Article  PubMed  Google Scholar 

  48. Martinucci I, Savarino EV, Pandolfino JE et al. Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD. Neurogastroenterol Motil. 2016;28(2):243–50. https://doi.org/10.1111/nmo.12719.

    Article  CAS  PubMed  Google Scholar 

  49. Lee JS, Collard HR, Anstrom KJ et al. Anti-acid treatment and disease progression in idiopathic pulmonary fibrosis: an analysis of data from three randomised controlled trials. Lancet Respir Med. 2013;1(5):369–76. https://doi.org/10.1016/S2213-2600(13)70105-X.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lee JS, Ryu JH, Elicker BM et al. Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;184(12):1390–4. https://doi.org/10.1164/rccm.201101-0138OC.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Lee CM, Lee DH, Ahn BK et al. Protective effect of proton pump inhibitor for survival in patients with gastroesophageal reflux disease and idiopathic pulmonary fibrosis. J Neurogastroenterol Motil. 2016;22(3):444–51. https://doi.org/10.5056/jnm15192.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Fidler L, Sitzer N, Shapera S, Shah PS. Treatment of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Chest. 2018;153(6):1405–1415. https://doi.org/10.1016/j.chest.2018.03.008.

    Article  PubMed  Google Scholar 

  53. Lo WK, Goldberg HJ, Boukedes S, Burakoff R, Chan WW. Proton pump inhibitors independently protect against early allograft injury or chronic rejection after lung transplantation. Dig Dis Sci. 2018;63(2):403–410. https://doi.org/10.1007/s10620-017-4827-0.

    Article  CAS  PubMed  Google Scholar 

  54. Jo HE, Corte TJ, Glaspole I et al. Gastroesophageal reflux and antacid therapy in IPF: analysis from the Australia IPF Registry. BMC Pulm Med. 2019;19(1):84. https://doi.org/10.1186/s12890-019-0846-2.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tran T, Assayag D, Ernst P, Suissa S. Effectiveness of proton pump inhibitors in idiopathic pulmonary fibrosis: a population-based cohort study. Chest. 2021;159(2):673–682. https://doi.org/10.1016/j.chest.2020.08.2080.

    Article  CAS  PubMed  Google Scholar 

  56. Ghebremariam YT, Cooke JP, Gerhart W et al. Pleiotropic effect of the proton pump inhibitor esomeprazole leading to suppression of lung inflammation and fibrosis. J Transl Med. 2015;13:249. https://doi.org/10.1186/s12967-015-0614-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Raghu G, Morrow E, Collins BF et al. Laparoscopic anti-reflux surgery for idiopathic pulmonary fibrosis at a single centre. Eur Respir J. 2016;48(3):826–32. https://doi.org/10.1183/13993003.00488-2016.

    Article  PubMed  Google Scholar 

  58. Hartwig MG, Anderson DJ, Onaitis MW et al. Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Ann Thorac Surg. 2011;92(2):462–8. https://doi.org/10.1016/j.athoracsur.2011.04.035.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Lo WK, Goldberg HJ, Wee J, Fisichella PM, Chan WW. Both pre-transplant and early post-transplant antireflux surgery prevent development of early allograft injury after lung transplantation. J Gastrointest Surg. 2016;20(1):111–8. https://doi.org/10.1007/s11605-015-2983-0.

    Article  PubMed  Google Scholar 

  60. Lo WK, Goldberg HJ, Sharma N, Wee JO, Chan WW. Routine reflux testing guides timely anti-reflux treatment to reduce acute and chronic rejection after lung transplantation. Clin Transl Gastroenterol. 2022. https://doi.org/10.14309/ctg.0000000000000538.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Klauser AG, Schindlbeck NE, Muller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990;335(8683):205–8. https://doi.org/10.1016/0140-6736(90)90287-f.

    Article  CAS  PubMed  Google Scholar 

  62. Jones R, Junghard O, Dent J et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009;30(10):1030–8. https://doi.org/10.1111/j.1365-2036.2009.04142.x.

    Article  CAS  PubMed  Google Scholar 

  63. Jonasson C, Wernersson B, Hoff DA, Hatlebakk JG. Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013;37(5):564–72. https://doi.org/10.1111/apt.12204.

    Article  CAS  PubMed  Google Scholar 

  64. Lechien JR, Bobin F, Muls V et al. Validity and reliability of the reflux symptom score. Laryngoscope. 2020;130(3):E98–E107. https://doi.org/10.1002/lary.28017.

    Article  CAS  PubMed  Google Scholar 

  65. Sweet MP, Herbella FA, Leard L et al. The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation. Ann Surg. 2006;244(4):491–7. https://doi.org/10.1097/01.sla.0000237757.49687.03.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Joyce C. Zhou

  2. Harvard Medical School, Boston, MA, USA

    Joyce C. Zhou, Walter W. Chan & Wai-Kit Lo

  3. Division of Digestive and Liver Diseases, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Sravanya Gavini

  4. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Walter W. Chan & Wai-Kit Lo

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JCZ—None; SG—None; WWC—Scientific Advisory Board (Takeda Pharmaceuticals, Phathom Pharmaceuticals, Sanofi Pharmaceuticals); WKL—None.

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Zhou, J.C., Gavini, S., Chan, W.W. et al. Relationship Between Esophageal Disease and Pulmonary Fibrosis. Dig Dis Sci 68, 1096–1105 (2023). https://doi.org/10.1007/s10620-023-07908-2

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