GORD diagnosis, treatment has little bearing on IPF survival
Being diagnosed or treated for gastro-oesophageal reflux disease (GORD) has little impact on the survival outcomes of patients with idiopathic pulmonary fibrosis (IPF), according to a study presented as a poster at APSR 2017.
Researchers from Australia examined data of 587 patients who were enrolled in the Australian IPF Registry (mean age 71 years, 69 percent male) following IPF diagnosis by a respiratory physician. Upon inclusion in the Registry, patients were asked to answer a questionnaire which included information on comorbidities, medication use, and symptoms scores of both IPF and GORD. Of these, 65 percent of patients (n=384) were receiving treatment for GORD.
Patients who had been diagnosed with GORD had a higher likelihood of being treated with anti-acids (odds ratio [OR], 5.67; p<0.001), as were individuals with GORD symptoms such as heartburn and reflux (OR, 3.03; p<0.001) and those with more symptoms reported on the frequency scale for the symptoms of GORD (FSSG; OR, 1.09; p<0.001).
Diagnosis of GORD did not significantly impact overall survival (OS; hazard ratio [HR], 0.90) or progression-free survival (PFS; HR, 1.12) in patients with IPF, nor did the GORD treatments of proton pump inhibitors or H2 blockers (HR, 1.02 and 1.20 for OS and PFS, respectively). [APSR 2017, abstract AP288]
However, in terms of the acid reflux questions on the FSSG questionnaire, those in the highest score tertile had a tendency towards better OS outcomes (HR, 0.81; p=0.048).
Patients with a history of smoking had poorer OS and PFS (HR, 1.38; p=0.032 and HR, 1.31; p=0.023 for OS and PFS, respectively), while older age and lower BMI were linked to poorer OS (HR, 1.03; p=0.001 and HR, 0.95; p=0.002, respectively), but not PFS.
According to the researchers, GORD is a common condition in patients with IPF, with chronic micro-aspiration potentially contributing to the pathogenesis of IPF and IPF predisposing to the development of GORD.
“There is conflicting evidence surrounding the potential of anti-acid treatment to slow IPF progression and improve survival,” they said. Thus, the aim of the study was to “investigate the relationship between GORD symptoms, diagnosis, and treatment in patients with IPF” as well as the impact of GORD on the outcome.
“[This study showed that] while patients who were on anti-acid treatment had better lung function, there was no significant difference in [OS and PFS] … [and neither] the diagnosis of GORD, nor the presence of typical GORD symptoms influenced survival,” they said.
“Patients with higher scores on the FSSG reflux questions however, did have a trend towards better [OS],” they said.