PURPOSE: Purpose: Recurrent respiratory symptoms in children can be caused by micro-aspiration of gastric contents into the lung. Pepsin may be a better marker of chronic aspiration of gastric reflux than the quantification of lipid-laden macrophages. We hypothesize that the detection of moderate quantities of pepsin in the bronchial lavage fluid (BAL) will correlate with other imaging studies revealing significant reflux and dysfunctional swallowing mechanisms.
METHODS: Methods: This study is a retrospective chart review of 21 patients who had a diagnostic bronchial lavage and a pepsin assay. Demographic data, respiratory status and image studies were collected via medical records. The pepsin was measured by an enzymatic methods using flourescein isothiocyanate (FITC) casein as substrate. The final concentration was determined based on the net fluorescent intensity of the known concentration of the standards.
RESULTS: Results: The 21 children consisted of 8 boys and 13 girls with an average age of 4.4 yr +/- 4.3, ranging from 5 months to 15 years. 15 children had positive pepsin detected in the BAL (71%). The positive pepsin results ranged from 20 ng/ml to 733 ng/ml with 60 % of the results > 50 ng/ml and 40% < 50 ng/ml. Within the group of the children (n= 19, 90%), who were diagnosed with moderate gastric reflux, 14 children had pepsin detected in the BAL (73%). Furthermore, 71% of the children with an abnormal swallowing mechanism (n= 5/7) had pepsin detected in the BAL.
CONCLUSION: Conclusion: These preliminary results of an ongoing retrospective study reveal that moderate gastric reflux,or an abnormal swallow mechanism and pepsin in the bronchial lavage suggest that silent aspiration is cause for recurrent respiratory symptoms.
CLINICAL IMPLICATIONS: Clinical Implications: The diagnosis of aspiration in otherwise normal children would provide important information for interventional medical therapy.
DISCLOSURE: Katherine King, No Financial Disclosure Information; No Product/Research Disclosure Information