Γαζηνμμηζμθαγηθή παιηκδνόμεζε θαη ηδημπαζήξ πκεομμκηθή ίκςζε. Ζςή Δακηήι Πκεομμκμιμγηθή Ιιηκηθή Θαηνηθή Σπμιή Πακεπηζηεμίμο Θεζζαιίαξ

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1 Γαζηνμμηζμθαγηθή παιηκδνόμεζε θαη ηδημπαζήξ πκεομμκηθή ίκςζε Ζςή Δακηήι Πκεομμκμιμγηθή Ιιηκηθή Θαηνηθή Σπμιή Πακεπηζηεμίμο Θεζζαιίαξ

2 Θδημπαζήξ Πκεομμκηθή Ίκςζε ( Idiopathic pulmonary fibrosis IPF) Specific form of chronic fibrosing interstitial pneumonia limited to the lung, associated with UIP on lung biopsy. International Consensus Statement, AJRCCM2000

3 Η αηηημιμγία ηεξ ηδημπαζμύξ πκεομμκηθήξ ίκςζεξ (ΘΠΘ) παναμέκεη άγκςζηε

4 Ahmed Fahim et al Pulmonary Medicine 2011

6 1 μήκα μεηά

7 Patients with IPF have a high prevalence of increased esophageal acid exposure, usually without typical GER symptoms. Acid reflux may be a contributing factor in the pathogenesis of IPF

8 Abnormal distal oesophageal acid exposure was defined by a ph of,4 for o4.5% of the total time by the most distal ph sensor Abnormal proximal oesophageal acid exposure was defined by a ph of,4 for o1% of the total time by the most proximal ph sensor Abnormal acid GER was significantly more common in IPF patients than asthma patients. Only 47% of IPF patients experienced classic GER symptoms

9 King TE; AJRCCM 2001; 164: Katzenstein ALA et al. AJRFCCM 1998;157:1301 Pathogenesis and course UIP UIP Multiple microscopic foci of injury occurring over many years Focal fibroblast proliferation (fibroblastic foci) Collagen deposition Progressive clinical course Recurrent microscopic injury Death

10 King TE; AJRCCM 2001; 164: Katzenstein ALA et al. AJRFCCM 1998;157:1301 Pathogenesis and course UIP UIP Multiple microscopic foci of injury occurring over many years Focal fibroblast proliferation (fibroblastic foci) Collagen deposition Progressive clinical course Recurrent microscopic injury Death

11 Η μαθνμπνόκηα ηναπεημβνμγπηθή εηζννόθεζε μηθνήξ πμζόηεηαξ γαζηνηθμύ πενηεπμμέκμο ιόγς γαζηνμμηζμθαγηθήξ παιηκδνόμεζεξ (gastroesophageal reflux GER) μπμνεί κα απμηειεί αηηία επακαιαμβακόμεκςκ μηθνμβιαβώκ ζημ θορειηδηθό επηζήιημ με ηειηθό απμηέιεζμα ηεκ ακάπηολε πκεομμκηθήξ ίκςζεξ Pearson JE et al Thorax 1971;26: Mays EE et al. Chest 1976;69: Raghu G et al Chest 2006;129: Lee JS et al Am J Med 2010;123:

12 HCl, 2 weeks, right lung. Area of scarring showing complete loss of the alveolar architecture due to abundant deposition of collagen fibers with interspersed fibroblast

13 After adjustment, the use of GER medications was an independent predictor of longer survival time. In addition, the use of gastroesophageal reflux medications was associated with a lower radiologic fibrosis score

16 Although the use of pharmacological agents that suppress acidity have been associated with disease stabilisation and improved survival, it must be emphasised that the GER and aspiration per se are not suppressed by PPI, and aspiration with alkaline gastric juice can still occur

17 Progression of idiopathic pulmonary fibrosis: lessons from asymmetrical disease Tcherakian C, Cottin V, Brillet PY, Freynet O, Naggara N, Carton Z, Cordier JF, Brauner M, Valeyre D, Nunes H. Thorax 2011;66: The study included 32 IPF patients (26 men, mean±sd age 69±7 years) with asymmetrical disease (AIPF) and Conclusion AIPF may be related to locoregional factors including gastrooesophageal reflux which may be responsible for both disease expansion and the occurrence of acute exacerbations. 64 matched controls with symmetrical IPF In patients with AIPF the right side was more likely to be involved (62.5%) The rate of gastro-oesophageal reflux and acute exacerbations was significantly higher in patients with AIPF (62.5% vs 31.3%, p=0.006 and 46.9% vs 17.2%, p=0.004, respectively)

18 Pepsin level was an indicator of acute exacerbation status (p<0.04). On average, pepsin appeared higher in patients with acute exacerbations compared with stable controls. This difference was driven by a subgroup of eight patients (33%) with pepsin levels >70 ng/ml-1.

19 Η επίπηςζε θαη μ επηπμιαζμόξ ηεξ ΘΠΘ εθηημάηαη ζημ 71 θαη 271 ακά πιεζοζμό ακηηζημίπςξ γηα ημοξ άκδνεξ θαη ζημ 67 θαη 266 γηα ηηξ γοκαίθεξ ειηθίαξ > 75 εηώκ Σημ γεκηθό πιεζοζμό ε επίπηςζε θαη μ επηπμιαζμόξ ηεξ ΘΠΘ εθηημάηαη ζημ 16,3 θαη 42,7 ακά πιεζοζμό Raghu G, et al Am J Respir Crit Care Med 2006;174:

20 Ο γεναηόξ πκεύμμκαξ πανμοζηάδεη μεγαιύηενε εοαηζζεζία ζηεκ ακάπηολε ίκςζεξ μεηά από ηεκ έθζεζε ζε μηα πμηθηιία ενεζηζμάηςκ, γεγμκόξ πμο απμδίδεηαη ζε μεηαβμιέξ πμο ζπεηίδμκηαη με ηεκ ειηθία θαη ακαθένμκηαη ζηε γμκηδηαθή έθθναζε ή ζε γεκεηηθμύξ πμιομμνθηζμμύξ. Πανάδεηγμα απμηειεί ε δοζιεηημονγία ηεξ ηειμμενάζεξ πμο έπεη ζπέζε με ηεκ ειηθία King TE Jr, et al Lancet 2011; 378: Tsakiri K, Proc Natl Acad Sci USA 2007; 104:

21 Οη εθηθηςμέκμη επίζεξ πανμοζηάδμοκ: Μεηςμέκε θηκεηηθόηεηα μηζμθάγμο θαη ζημμάπμο Μεηςμέκε πίεζε ημο άκς μηζμθαγηθμύ ζθηγθηήνα Αύλεζε ηεξ έθζεζεξ ημο μηζμθάγμο ζημ όληκμ πενηεπόμεκμ ημο ζημμάπμο Δηαθναγμαημθήιε παναηενείηαη ζημ 60% ηςκ αηόμςκ ειηθίαξ άκς ηςκ 60 εηώκ Patti MG, et al Am J Surg 1996; 171:

23 Am J Respir Crit Care Med 2011; 183:

24 EVIDENCE-BASED TREATMENT RECOMMENDATIONS? Raghu G. Eur Respir J 2011; 37: 743-6

25 Ευχαριστώ!

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