| Autor: |
Khor YH; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia., Bissell B; Acute Care Pharmacy Services, University of Kentucky HealthCare, and.; Pharmacy Practice and Science Department, College of Pharmacy, University of Kentucky, Lexington, Kentucky., Ghazipura M; ZS Associates, Global Health Economics and Outcomes Research, New York, New York.; Divisions of Epidemiology and Biostatistics, Department of Population Health, and., Herman D; Department of Medicine, The Ohio State University, Columbus, Ohio., Hon SM; Department of Medicine, School of Medicine, Tufts University, Boston, Massachusetts., Hossain T; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Grossman School of Medicine, New York University Langone Health, New York, New York., Kheir F; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Knight SL; Library and Knowledge Sciences, National Jewish Health, Denver, Colorado., Kreuter M; Center for Interstitial and Rare Lung Diseases, Department of Pneumology, University Hospital Heidelberg and German Center for Lung Research, Heidelberg, Germany., Macrea M; Department of Medicine, Veterans Affairs Medical Center, Salem, Virginia., J Mammen M; Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York., Molina-Molina M; Department of Respiratory, University Hospital of Bellvitge, Barcelona, Spain., Selman M; Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas,' Mexico City, Mexico., Wijsenbeek M; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands., Raghu G; Department of Medicine, School of Medicine, University of Washington, Seattle, Washington; and., Wilson KC; Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts. |
| Abstrakt: |
Rationale: Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial pneumonia with impaired survival. Previous guidelines recommend antacid medication to improve respiratory outcomes in patients with IPF. Objectives: This systematic review was undertaken during the development of an American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax guideline. The clinical question was, "Should patients with IPF who have documented abnormal gastroesophageal reflux (GER) with or without symptoms of GER disease 1 ) be treated with antacid medication or 2 ) undergo antireflux surgery to improve respiratory outcomes?" Methods: Medline, Embase, the Cochrane Central Register of Controlled Trials, and the gray literature were searched through June 30, 2020. Studies that enrolled patients with IPF and 1 ) compared antacid medication to placebo or no medication or 2 ) compared antireflux surgery to no surgery were selected. Meta-analyses were performed when possible. Outcomes included disease progression, mortality, exacerbations, hospitalizations, lung function, respiratory symptoms, GER severity, and adverse effects/complications. Results: For antacid medication, when two studies were aggregated, there was no statistically significant effect on disease progression, defined as a 10% or more decline in FVC, more than 50-m decline in 6-minute walking distance, or death (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.76-1.03). A separate study that could not be included in the meta-analysis found no statistically significant effect on disease progression when defined as a 5% or more decline in FVC or death (RR, 1.10; 95% CI, 1.00-1.21) and an increase in disease progression when defined as a 10% or more decline in FVC or death (RR, 1.28; 95% CI, 1.08-1.51). For antireflux surgery, there was also no statistically significant effect on disease progression (RR, 0.29; 95% CI, 0.06-1.26). Neither antacid medications nor antireflux surgery was associated with improvements in the other outcomes. Conclusions: There is insufficient evidence to conclude that antacid medication or antireflux surgery improves respiratory outcomes in patients with IPF, most of whom had not had abnormal GER confirmed. Well-designed and adequately powered prospective studies with objective evaluation for GER are critical to elucidate the role of antacid medication and antireflux surgery for respiratory outcomes in patients with IPF. |
