The silent IPF trigger: How to manage GERD to protect your airways

Untreated chronic GERD can worsen IPF and in some cases can be the cause of other types of pulmonary fibrosis, says Blaine Kenaa, MD, a pulmonary and critical care physician and an assistant professor of medicine at the University of Maryland School of Medicine in Baltimore. This acidic content can cause irritation and ongoing inflammation to the lungs which results in the worsening of the scarring or fibrosis of the lung.

GERD can often be effectively managed by making lifestyle and diet modifications. Your doctor may also prescribe medications when these arent enough to control your symptoms.

The Stomach-Lung Connection

There has long been a debate around the relationship between GERD and IPF, says Corey Kershaw, MD, a pulmonary and critical care physician and a professor of internal medicine at UT Southwestern Medical School in Dallas. Specifically, is there merely an association, or is there truly a cause and effect relationship?

This gives the false reassurance that they dont need treatment for GERD, though they might still have the complication of the ongoing lung inflammation, says Dr. Kenaa. She says people with silent reflux may experience coughing:

• After a heavy meal
• After eating food with a high acid content
• While lying flat
• While sleeping

Kershaw says you may need to see both a pulmonologist and a gastroenterologist to get to the bottom of your symptoms.

Lifestyle and Behavioral Tips

You may be able to manage GERD on your own by making a few changes to your habits.

Elevate Your Upper Body in Bed

Elevate the head of the bed on 4-6 inch blocks, or sleep on a foam wedge obtained from a medical supply house, says Kershaw. Sleeping on more pillows may make GERD worse, as they bend you in the wrong place and increase pressure on the stomach.

Stop Late-Night Eating

Avoid eating within three hours of bedtime, says Garfield. A short interval between the last meal and lying down is one of the strongest predictors of nighttime reflux.

It will also help to keep meals small. Consider four or five smaller meals throughout the day rather than three large ones to reduce stomach distension, she says.

Track Your Triggers

Try to figure out things that trigger reflux for you. Some common culprits:

• Foods and Beverages Kershaw says products containing caffeine, such as cola drinks, coffee, tea, and chocolate can cause problems for many people. Other common trigger foods include high-acid fruits and vegetables, such as citrus fruits, pineapple, tomatoes or tomato-based dishes, and items containing spearmint or peppermint.

As triggers vary from person to person, keeping a food diary can be very helpful, says Garfield.

GERD as a Side Effect of IPF Medications

Some medications can cause GERD as a side effect, including those used to treat IPF. There are currently three treatments approved by the U.S. Food and Drug Administration (FDA) for IPF:

• nintedanib (Ofev)
• pirfenidone (Esbriet)
• nerandomilast (Jascayd)

Other GI side effects, like diarrhea, nausea, and vomiting, can worsen reflux symptoms, Kershaw says, but she cautions not to stop taking your medication. GI side effects can usually be managed with dose adjustments, timing changes, and supportive medications, she says. Stopping antifibrotics to avoid stomach upset could allow the lung disease to progress more rapidly.

Kenaa says GERD symptoms happen most often in the first three months of treatment with pirfenidone, so you may be able to wait it out. Other ways to lessen these side effects:

• Take the medication with food.
• Apply lifestyle modifications.
• Add acid suppressing medications.
• Reduce the dose (if your doctor recommends.)

When to Talk to Your Doctor

If lifestyle changes arent enough to relieve your symptoms, your doctor may be able to give you more treatment options.

Patients should talk to their doctor about GERD in the setting of IPF if they continue to be symptomatic despite lifestyle modifications, says Kershaw. I would also recommend discussing a cough with your doctor, asking if untreated or silent GERD could be the cause. We shouldnt presume cough in IPF is always due to the lung disease itself.

If you are experiencing the following symptoms, says Garfield, you should get a medical evaluation.

• Persistent heartburn, regurgitation, or chest discomfort despite lifestyle modifications
• A chronic cough that worsens after meals or when lying down
• Unexplained worsening of IPF symptoms (increased breathlessness, declining lung function) that could be driven by silent reflux
• Difficulty tolerating antifibrotic medications due to nausea or GI symptoms
• Hoarseness, sore throat, or a sour taste in your mouth when you wake up

The Takeaway