Impact of gastroesophageal reflux disease on idiopathic pulmonary fibrosis and lung transplant recipients.

PURPOSE OF REVIEW: Idiopathic pulmonary fibrosis (IPF) is a prevalent subset of interstitial lung disease (ILD) that often progresses to require lung transplantation. Gastroesophageal reflux disease (GERD) is common in the IPF population, and GER-related micro-aspiration appears to be an important risk factor for IPF pathogenesis and for the deterioration of transplanted lung function. RECENT FINDINGS: Many patients with IPF have elevated esophageal acid exposure on reflux testing despite having no or minimal symptoms. Studies on the effects of medical GERD therapy on IPF-related outcomes have had mixed results. Antireflux surgery is safe in appropriately selected IPF patients, and appears to have potential for slowing the decline of lung function. GERD can persist, improve or develop after lung transplantation, and the presence of GERD is associated with allograft injury and pulmonary function decline in lung transplant recipients. SUMMARY: Clinicians should have a low threshold to assess for objective evidence of GERD in IPF patients. Antireflux surgery in IPF patients with GERD appears to improve lung function, but further studies are needed before surgical treatment can be recommended routinely in this setting. In lung transplant recipients, reflux testing after transplant is the most accurate way to guide GERD treatment decisions.

Intradural disk herniation at L1-L2: report of two cases.

CONTEXT: Lumbar intradural disk herniation (IDH) is a rare but serious complication of spinal disk protrusions. Although the pathogenesis of lumbar IDH is still vague, it is believed to be associated with the adhesion of the posterior longitudinal ligament with the ventral wall of the dura. Diagnosis is still difficult despite current neuroradiologic imaging techniques. FINDINGS: Two women, ages 63 and 69 years, presented with recent exacerbation of back pain. In each case, imaging studies revealed a ventral herniated disk at L1-L2. Both patients underwent surgery and in both cases a hard mass was palpated through the dura. Both patients experienced immediate postoperative relief of back pain following surgery. One patient required fusion and postoperative rehabilitation; her neurologic deficit returned to baseline. CONCLUSION/CLINICAL RELEVANCE: Prompt surgical intervention is indicated for IDH; disk removal allows for symptomatic relief and minimization of neurologic deficit.