Role of antioxidants in the treatment of gastroesophageal reflux disease-associated idiopathic pulmonary fibrosis

Abstract

Purpose of reviewIdiopathic pulmonary fibrosis (IPF) is a terminal lung disease of largely unknown cause. Gastroesophageal reflux disease (GERD) was recently discovered to be a trigger for the development of IPF. The current pharmaceutical approach to IPF falls short and there is a pressing need for improved therapeutic options. The present review describes the currently available knowledge regarding the role of oxidative stress and inflammation in the pathophysiology of IPF and GERD and determines the potential use of antioxidants as a treatment option for GERD-associated IPF.Recent findingsIPF and GERD share a similar pathophysiology, as oxidative stress and inflammation play a pivotal role in both conditions. This raises the question whether antioxidant treatment could be a well-tolerated and effective means to alleviate at least some of the symptoms of both conditions. In IPF, antioxidant supplementation complements the inadequately working antioxidant defense system of the lung, reducing oxidative stress and inflammation. In GERD, antioxidants increase levels of endogenous antioxidants, decrease pepsin and gastric acid production, lipid peroxidation, and ulceration, and alleviate subsequent damage to the gastric mucosa.SummaryThe increased comorbidity of GERD in IPF patients makes it clear that there is a connection between GERD and IPF. As current treatment options are still inadequate to improve the condition and increase the survival rate of IPF patients, alternative treatment options are crucial. Based on the reviewed scientific evidence, antioxidant supplementation could complement standard IPF treatment, certainly in GERD-associated IPF.