GERD and lung disease

In the March 2014 edition of ACP Internist (American College of Physicians News for Internist publication)  an excellent article by Leah Lawrence  described what is known and not known between a possible link from gastroesophageal reflux disorder (GERD) and pulmonary diseases.  GERD can be asymptomatic and, thus, missed as a possible link to a patient’s pulmonary symptoms. A variety of lung diseases are associated with GERD: asthma, aspiration pneumonia, chronic cough and even idiopathic pulmonary fibrosis (IPF) have been linked.  However, being “linked” does not necessarily infer “causation”. A relationship may exist but being certain that GERD and these other diseases are caused by the GERD is another conclusion that cannot be made. Therefore, consider this a “possible relationship” and therefore, being aware of certain lung illnesses possibly being associated with GERD is important.  In terms of a pathway for causation of airway disease and GERD two mechanisms are proposed: the direct aspiration of gastric content into the lungs and the possibility of a reflex arc due to commonly shared embryonic nervous connections eliciting or provoking bronchospasm may be involved.  Chronic cough is frequently ascribed to GERD as one of the causes. However, I believe importantly that “at this time, we have only been able to prove that the two conditions co-exist” but that “we have been unable to establish causality” has been stated by Dr. Lauren Gerson who authored the American College of Gastroenterology’s guidelines on GERD.  With regards to IPF, again, there is debate as to how, if at all, GERD and IPF relate to each other. Dr. Joyce Lee from UCSF published a study “that found that patients with IPF who used GERD medication had a median survival time that was twice that of patients who did not use the drugs”.  Thus, considering GERD as a possible associated illness with patient who have lung disease may lend itself to considering an evaluation for GERD and, if found, lifestyle modification  and/or medication to tackle this disorder may be in order.