Role of diabetes mellitus and gastro-oesophageal reflux in the aetiology of idiopathic pulmonary fibrosis

Respir Med. 2009 Jun;103(6):927-31. doi: 10.1016/j.rmed.2008.11.001. Epub 2008 Dec 6.


Background: The aetiology of idiopathic pulmonary fibrosis remains poorly understood, but recent studies have suggested that diabetes mellitus and gastro-oesophageal reflux may be risk factors.

Objective: To test possible associations between diabetes mellitus and gastro-oesophageal reflux with idiopathic pulmonary fibrosis in the general population.

Methods: We designed a case-control study in the setting of UK general practices contributing data to The Health Improvement Network primary care database (THIN). We selected patients over 40 years of age with a first diagnosis of idiopathic pulmonary fibrosis, and up to 4 controls per case matched by age, gender, and general practice. We estimated odds ratios for exposure to gastro-oesophageal reflux, gout, hypercholesterolaemia and diabetes mellitus using conditional logistic regression. We explored the role of confounding by smoking habit, socio-economic status, and medication with prednisolone.

Results: Amongst our 920 cases we found increased risks of use of insulin (odds ratio (OR) 2.36; 95% confidence interval (CI) 1.46-3.83) and use of ulcer drugs (OR 2.20; 95% CI 1.88-2.58). These were almost unchanged when we excluded cases and controls who had been prescribed prednisolone. We found no association with hypercholesterolaemia or gout, nor with smoking status or socio-economic status.

Conclusions: The study provides further evidence of an association between idiopathic pulmonary fibrosis and both diabetes mellitus and gastro-oesophageal reflux.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Allopurinol / therapeutic use
  • Antacids / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Diabetes Complications*
  • Diabetes Mellitus / drug therapy
  • Epidemiologic Methods
  • Family Practice / statistics & numerical data
  • Female
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / drug therapy
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Idiopathic Pulmonary Fibrosis / etiology*
  • Male
  • Middle Aged
  • Prednisolone / therapeutic use
  • Smoking / epidemiology
  • United Kingdom


  • Antacids
  • Anti-Inflammatory Agents
  • Hypoglycemic Agents
  • Allopurinol
  • Prednisolone