Gastro-oesophageal reflux and idiopathic pulmonary fibrosis: in search of evidence.

Gastro-oesophageal reflux (GOR) is a frequent comorbidity in many chronic respiratory conditions, particularly in idiopathic pulmonary fibrosis (IPF) [1]. However, the evidence that GOR contributes to the pathophysiology of IPF and that interventions aimed at controlling GOR may influence the evolution of lung fibrosis remains elusive. Despite that, the 2015 update of the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association clinical practice guidelines for IPF provides a conditional recommendation for antacid treatment as a possible treatment for IPF [2], albeit with very low confidence in estimates of effect because data on the efficacy of antacid therapy effect are limited. The same guidelines provide a conditional recommendation for pirfenidone and nintedanib treatment in patients with IPF based on the results of phase 3 randomised controlled trials [2].