Anti-reflux surgery promising in some with pulmonary fibrosis

Last Updated: 2018-08-24

By David Douglas

NEW YORK (Reuters Health) - In patients with idiopathic pulmonary fibrosis (IPF), laparoscopic fundoplication to treat acid gastroesophageal reflux may be of benefit, according to a phase 2 clinical trial.

As Dr. Ganesh Raghu told Reuters Health by email, "Surgery was well tolerated by the patients and was determined to be safe. The overall totality of the results was favorable and warrants further study in larger patient populations."

Reflux is thought to play a role in the progression of IPF, so surgical treatment might slow the disease, Dr. Raghu of the University of Washington, in Seattle, and colleagues note in The Lancet Respiratory Medicine, online August 9.

To investigate, the researchers randomized 58 patients with abnormal gastric reflux and preserved forced vital capacity (FVC) to laparoscopic anti-reflux surgery or no surgery.

Based on intention-to-treat analysis adjusted for baseline anti-fibrotic use, the adjusted rate of decline in FVC over 48 weeks was numerically in favor of the surgery group (-0.05 L vs. 0.13 L, P=0.28). Worst-rank analysis showed that the between-group difference was significant, favoring the surgery group.

One surgery-group patient died, as did four in the non-surgery group. Acute exacerbation and respiratory-related hospitalization were also less common in the surgery group.

Co-author Dr. Harold R. Collard of the University of California, San Francisco, told Reuters Health by email that "anti-reflux surgery appears safe and well tolerated in patients with IPF, and . . . further study of its efficacy is warranted."

Dr. Kerri A. Johannson of the University of Calgary, in Canada, who wrote a linked editorial, said, "This well-conducted study shows clear trends towards an efficacy signal of laparoscopic anti-reflux surgery to improve clinical outcomes in a subset of patients with IPF."

"The findings," he told Reuters Health by email, "are preliminary and not ready for implementation in clinical practice, but certainly indicate that further research is warranted in this area."

SOURCE: https://bit.ly/2o7p4rx and https://bit.ly/2MPPDPN

Lancet Respir Med 2018.