Antacid therapy and disease outcomes in idiopathic pulmonary fibrosis: flip side of the story.

It is well appreciated that majority of idiopathic pulmonary fibrosis (IPF) patients have gastric disorders including gastroesophageal reflux disease (GERD), dyspepsia and gastritis . Accordingly, IPF patients are often prescribed antacid therapy such as histamine H2-receptor antagonists (H2RA) and proton pump inhibitors (PPIs). Occasionally, patients who repeatedly failed these medical interventions are referred to undergo surgical procedures to repair a segment of the esophagus and reinforce the closing function of the lower esophageal sphincter (LES). The later intervention is often more durable and effective in preventing the reflux of gastric juice and possible aspiration into the respiratory system . However, despite limitations of the medical interventions, the use of H2RA and PPIs in IPF is still very common. Accordingly, a number of clinical studies have anecdotally and retrospectively assessed the safety and efficacy of antacid therapy in IPF.