RESUMO
Idiopathic pulmonary fibrosis (IPF) and gastroesophageal reflux disease (GERD) are undoubtedly related. Even though it is not clear yet which one is the primary disease, they certainly interact increasing each other's severity. Symptoms are unreliable to diagnose GERD in patients with IPF, and objective evaluation with pH monitoring and/or bronchoalveolar lavage analysis is mandatory. Pharmacological treatment with proton pump inhibitors (PPIs) may bring control of IPF in few patients, but PPIs do not control reflux but just change the pH of the gastric refluxate. Surgical therapy based on a fundoplication is safe and effective as it controls any type of reflux, independently from the pH of the gastric refluxate. In patients waiting for lung transplantation (if they can tolerate a laparoscopic operation under general anesthesia), a fundoplication before the operation might block the progression of IPF, while after transplantation it might prevent rejection by preventing the bronchiolitis obliterans syndrome.
Assuntos
Refluxo Gastroesofágico/complicações , Fibrose Pulmonar Idiopática/complicações , Bronquiolite Obliterante/prevenção & controle , Lavagem Broncoalveolar , Progressão da Doença , Monitoramento do pH Esofágico , Fundoplicatura/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/cirurgia , Rejeição de Enxerto/prevenção & controle , Azia/tratamento farmacológico , Humanos , Fibrose Pulmonar Idiopática/cirurgia , Transplante de Pulmão , Inibidores da Bomba de Prótons/uso terapêutico , SíndromeRESUMO
Post-infectious bronchiolitis obliterans (BOPI) is a chronic obstructive disease, resulting from an acute injury and an abnormal repair process, with diffuse pulmonary fibrosis and peribronchiolar fibrosis, which cause chronic respiratory failure with prolonged oxygen dependence. The most common cause of this disease is severe bronchiolitis / pneumonia due to adenovirus (ADV), mainly in group B, before 2 years of age. In its pathogenesis are factors of the host and the characteristics of the virus that has mechanisms to prevent immunity and cause a chronic infection with great inflammatory response. This involves numerous cells (mainly lymphocytes) and cytokines that are produced by a chronic infection by ADV, which maintains a prolonged inflammatory process, determining different degrees of lung damage. In this article we will discuss the mechanisms by which this damage occurs.
La bronquiolitis obliterante postinfecciosa (BOPI) es una enfermedad obstructiva crónica, resultante de una injuria aguda y un proceso de reparación anómalo, con fibrosis pulmonar y peribronquiolar difusa, que causan insuficiencia respiratoria crónica con dependencia de oxigeno prolongada. La causa más frecuente de esta enfermedad es una bronquiolitis/neumonía grave por adenovirus (ADV), principalmente del grupo B, antes de los 2 años de vida. En su patogenia intervienen factores del huésped y las características del virus que tiene mecanismos para evitar la inmunidad y provocar una infección crónica con gran respuesta inflamatoria. En esta participan numerosas células (principalmente linfocitos) y citoquinas que se producen por una infección crónica por ADV, lo que mantiene un proceso inflamatorio prolongado, determinando distintos grados de daño pulmonar. En este artículo abordaremos los mecanismos por los cuales se produce este daño.
Assuntos
Humanos , Criança , Bronquiolite Obliterante/etiologia , Pneumonia Viral/complicações , Bronquiolite Obliterante/prevenção & controle , Bronquiolite Obliterante/epidemiologia , Infecções por Adenovirus Humanos/complicações , Fatores de RiscoRESUMO
OBJECTIVE: To investigate the effect of adipose tissue-derived mesenchymal stem cell (ASC) administered either systemically or locally in a murine model of bronchiolitis obliterans. RESULTS: When compared to controls, systemic treatment with 106 ASCs on D0 and a second dose on D7 significantly prevented tracheal obliteration 28 days after heterotopic tracheal transplantation (median of 94 vs. 16%; P < 0.01). A single dose tended towards less stenosis than controls, but did not reach statistical significance (28 vs. 94%; P = 0.054). On the contrary, repeated local injection was incapable of preventing tracheal obliteration when compared to a single injection or controls (37 vs. 71 vs. 87%). Two intravenous doses also tended to be better than two local injections (16 vs. 37%; P = 0.058), and were better than a single local dose (16 vs. 71%; P < 0.01). CONCLUSION: A second dose of ASC, given systemically after 7 days, reduces luminal obliteration in a heterotopic tracheal transplantation model in mice, suggesting that ASC can be used to prevent obliterative bronchiolitis after lung transplantation.