P62 GORD and PPI therapy in pulmonary fibrosis

Résumé fourni par la source

Introduction and Aims The role of Gastro-Oesophageal Reflux Disease (GORD) in pulmonary fibrosis is uncertain. There are theoretical concerns regarding the role of micro-aspiration and disease exacerbation, as well as observational studies documenting survival benefit. We aim to assess the impact of PPI therapy in patients with pulmonary fibrosis. Methods 223 patients attending the ILD clinic were followed for 3 years. They were stratified by radiological diagnosis; Unclassifiable pulmonary fibrosis (n 66), Probable UIP (n 51), and UIP (n 106). Demographics, pulmonary function tests, dedicated swallow assessments –where available, treatment and use of PPI were recorded. Outcome measures included rate of decline in FVC and death. A subgroup analysis (n 147) assessed the impact of PPI on progression defined by the INBUILD criteria. Results The average age of the cohort was 76.4 (8.8 SD), 63% male (n 141), 21% required O2, mortality during follow up was 36% (n 81). Demographic, baseline data, treatment and outcome for each radiological diagnosis are presented in table 1. 70% of patients received PPI treatment. Of those who underwent dedicated swallow assessment 51% had evidence of dysmotility, reflux or laryngeal penetration. There was similar rates of GORD in those with asymmetric versus uniform pulmonary fibrosis (47% v 55%). There was no significant differences in rate of FVC decline within the cohort as a result of treatment. There appeared to be attenuation of FVC decline by 48ml with treatment in patients with a UIP radiological classification, however this was not replicated in the pUIP group. The relative risk of death was reduced in those on treatment (RR 0.715, p 0.058), estimated benefit calculation suggested NNT 7.71. Review of INBUILD criteria outcomes revealed a 10% increase in progressive symptoms and FVC decline >10% in those on treatment however radiological progression was similar. Conclusions GORD is prevalent in pulmonary fibrosis. Treatment with PPI appeared to attenuate the rate of decline of FVC in some patients however did not alter progression defined by the INBUILD criteria. There was a suggestion of reduced mortality, further study is required to clarify the impact of PPI treatment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.