Is Heartburn Scarring My Lungs? GERD & Other Pulmonary Fibrosis Causes You Need to Know

Most of us have had heartburn — that feeling when stomach acid flows (refluxes) up into the esophagus. If you have gastroesophageal reflux disease (GERD), or the severe form of acid reflux, you need to know about its connection to lung scarring (pulmonary fibrosis).

Turns out there are lots of pulmonary fibrosis causes. GERD falls into a ‘maybe’ category.

We turned to lung disorder expert, Tessy K. Paul, MD, to explain the many potential pulmonary fibrosis causes. She also explains the lung connection with GERD.

Paul is medical director of the Interstitial Lung Disease Program at UVA Health. She’s also the center director for the Pulmonary Fibrosis Foundation Care Center Network at UVA Health.

What Is Pulmonary Fibrosis?

With pulmonary fibrosis (PF), the tissue around and between the airways in your lungs get scarred and thick. It’s the predominant finding in different chronic lung disorders. We call these interstitial lung disease (ILD).

This damage makes it hard to breathe and for your body to get the oxygen it needs. The terms interstitial lung disease and pulmonary fibrosis are often used interchangeably.

“Interstitial lung disease is an umbrella term. It encompasses a wide range of inflammatory and fibrotic lung diseases,” Paul says. “The cause can range from environmental exposures such as mold or having birds indoors to autoimmune diseases like scleroderma or rheumatoid arthritis. Or ILD can be ‘idiopathic’ where we don't know the cause.”

GERD: Chicken Or the Egg?

GERD and pulmonary fibrosis are a “chicken or egg” puzzle researchers haven’t yet solved. Researchers are looking to see:

• If GERD increases your risk for pulmonary fibrosis
• Or if pulmonary fibrosis leads to GERD and makes the condition worse

Paul explains: “With GERD, someone inhales small amounts of stomach contents into the lungs. This can cause inflammation and may promote scarring over time. And the other piece to the puzzle is whether having the lung fibrosis itself makes it more likely for these patients to develop GERD.”

With COVID-19, doctors saw a big increase in referrals for pulmonary fibrosis. Like with GERD, it’s hard to know if COVID caused the lung fibrosis. Or if the disease was already there and COVID made it worse or helped uncover it.

We do know this: Severe COVID-related lung fibrosis is one of the reasons people need a lung transplant.

More Possible Pulmonary Fibrosis Causes

In some cases, we can’t find a cause. We call this idiopathic pulmonary fibrosis. But, in addition to GERD, it’s important to know about things that can inflame and scar your lungs.

Breathing In Toxins at Work, Home or Outside

Many toxins and pollutants can damage your lungs over the long run. These include:

• Silica dust
• Asbestos fibers
• Hard metal dusts
• Coal dust
• Grain dust
• Bird and animal proteins
• Mold
• Smoking tobacco & e-cigs (vaping)
• Microwave popcorn flavoring

Radiation to the Chest for Cancer

Some people who receive radiation therapy for lung or breast cancer may show signs of lung damage months or sometimes years after the first treatment.

Medication for Cancer, Heart, & Other Conditions

Many drugs can damage your lungs, especially any of these medications you might need to take:

• Chemotherapy drugs designed to kill cancer cells, such as methotrexate and cyclophosphamide
• Irregular heartbeat medications such as amiodarone
• Antibiotics such as nitrofurantoin or ethambutol
• Anti-inflammatory drugs such as rituximab (Rituxan) or sulfasalazine (Azulfidine)

Autoimmune & Other Medical Conditions

Many medical conditions can damage the lungs. These include:

• Dermatomyositis
• Polymyositis
• Mixed connective tissue disease
• Systemic lupus erythematosus
• Scleroderma
• Rheumatoid arthritis
• Sarcoidosis

Important to Control GERD

Paul sees a lot of pulmonary fibrosis patients with GERD. Experts are looking to see if pulmonary fibrosis changes a person’s anatomy, making them more likely to have GERD.  

Here’s what we do know. “It’s important to control GERD when present and symptomatic in pulmonary fibrosis patients,” Paul says.

Worried About Pulmonary Fibrosis?

Pulmonary fibrosis often gets misdiagnosed or seems worse than it is. Some patients come to Paul terrified, thinking they have 3-5 years to live. “But many times, we're able to uncover more about the potential pulmonary fibrosis causes and the potential trajectory and natural history of their disease so they can get a better sense of their future.”

She adds, “Sometimes they don't have ILD at all. They might have had repeated pneumonia or something else masquerading as ILD." And not all patients with ILD have a dire prognosis.

"It's also important for patients to know we have ways to treat ILD," Paul says. "We recommend removing any potential exposure that may be culprits. Medical therapies can stabilize or even improve lung function in many cases. Supplemental oxygen and pulmonary rehabilitation are also important measures. And in advanced cases, patients may need a lung transplant.”

No matter the pulmonary fibrosis cause, ILD is challenging to diagnose and manage, Paul notes. “That’s why it’s important for patients to be seen in an academic medical center, and particularly UVA Health. “Here, they get access to experts and specialists to provide the multidimensional, comprehensive, and complex care they need.”