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?”
Some research suggests that GERD may increase your risk for IPF, a chronic condition in which lung tissue becomes thick and stiff.
“The concept that GERD can harm the lungs comes from the plausible theory that repeated aspiration of gastric contents causes direct injury to the lung cells,” says Dr. Kershaw. “The injury then repairs abnormally, resulting in a cascading process that results in lung fibrosis.”
GERD can cause what’s known as microaspiration: when tiny amounts of stomach content, including acid and digestive enzymes, travel up your esophagus and get inhaled into your lungs.
“This acts as a source of chronic, repetitive micro-injury — exactly the type of insult believed to drive the progressive scarring in IPF,” says Jamie Garfield, MD, a medical spokesperson for the American Lung Association. “The relationship appears to work in both directions, in that stomach contents that reflux upward can injure the lungs, while the stiff, scarred lungs of IPF alter pressure gradients across the diaphragm in ways that may worsen reflux.”
Not everyone with reflux experiences its more commonly recognized symptoms, such as heartburn and upper abdominal pain. That’s sometimes called “silent” reflux.
“This gives the false reassurance that they don’t 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.
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