Thread by @KaminskiMed

1/n September Pulmonary Fibrosis controversy thread about #IPFandGERD preprint from Dr. Cosetta Minelli's group: Two tweets from really good people say "GERD Causes IPF" (@IPFdoc, @drcjar), and a 3rd (@LungDrE) says: "Not based on your data".

Who is right?

2/n I read the preprint (medrxiv.org/content/10.110…); A Mendelian Randomization (MR) study using summary stats of GERD GWAS gut.bmj.com/content/71/6/1… & IPF GWAS meta-analysis thorax.bmj.com/content/77/8/8….
Shows OR of 1.6 GERD➡️IPF & 0.99 IPF➡️GERD. So what do I think?

#IPFandGERD

3/n #IPFandGERD Paper obviously needs #PeerReview. But there is context.
As a non-expert, in reading Mendelian Randomization studies I go back to the superb Guide to reading Mendelian randomization studies from Prof Davey Smith & team. Especially that 👇🏼
bmj.com/content/362/bm…

4/n Prof Davey Smith highlights need to triangulate the data. Using observational data, REPLICATED Mendelian randomization Trials, intervention studies, to infer causality, recommend action. Methinks that;s the answer to @IPFdoc, @drcjar @LungDrE #IPFandGERD causation argument

5/n Do we have the data to triangulate?
Maybe. Results of #WrapIPF testing laparoscopic anti-reflux surgery in patients with proven #GERDandIPF were as good as recent phase 2A studies (see 🧵 from @davidlederer)

https://twitter.com/davidlederer/status/1028299782614396928?s=20&t=-5jA--ltWspDWc1NQGNAAQ

but do we have enough to infer causation?

6/n there's much more (dovepress.com/idiopathic-pul…), but #TruthIs @LungDrE is RIGHT. The Reynolds/Minelli #IPFandGERD study does not prove GERD causes IPF. But it does suggest that the reverse causality - IPF causing GERD probably does not happen. New & VERY cool if replicated. Fin