Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration.

S. Farrell, C. McMaster, D. Gibson, M.D. Shields, W.A. McCallion

Research output: Contribution to journalArticle

103 Citations (Scopus)
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Abstract

OBJECTIVES: Gastro-oesophageal reflux (GOR)-related aspiration is associated with respiratory disease, but the current "gold standard" investigation, the lipid-laden macrophage index (LLMI), is flawed. A specific marker of GOR-related aspiration should originate in the stomach, but not the lung. An assay to detect gastric pepsin in the bronchoalveolar lavage (BAL) of children was developed and validated.METHODS: Gastro-oesophageal reflux was diagnosed in 33 children using intra-oesophageal pH monitoring. Thirteen asymptomatic negative controls requiring endotracheal intubation for elective surgery and 5 positive control patients with observed aspiration were recruited. All subjects received a BAL; the fluid obtained was analysed for the pepsin content and the LLMI.RESULTS: All subjects in the negative control group were negative for pepsin. The positive control group had a significantly greater median pepsin level (P <.01) compared with negative controls. Patients with proximal oesophageal GOR and chronic cough also had significantly elevated pepsin levels (P = .04). The LLMI was not significantly elevated by the presence of cough or GOR.CONCLUSIONS: This study suggests that GOR-related aspiration plays a role in chronic cough in children with known GOR. Detecting pepsin in BAL fluid may therefore become an important adjunct in patient selection for antireflux surgery.
Original languageEnglish
Pages (from-to)289-293
JournalJournal of Pediatric Surgery
Volume41
Issue number2
DOIs
Publication statusPublished - 2006

Keywords

  • Gastro-oesophageal reflux
  • bronchoalveolar lavage
  • pepsin
  • biomarker

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