Bile Acids in Sputum and Increased Airway Inflammation in Patients With Cystic Fibrosis

Dissecting the regulation of bile-induced biofilm formation in Staphylococcus aureus

“…The biofilm mode of growth is frequently associated with chronic infections as it allows the bacterium to evade host defences, and persist for extended periods of time (Furukawa et al, 2006). Our observation is consistent with the increased incidence of S. aureus in paediatric patients suffering from GERD (Palm et al, 2012;van der Doef et al, 2009), the likely source of bile acids in the lungs of these patients (Aseeri et al, 2012;Pauwels et al, 2012;Reen et al, 2014).…”

“…The aspiration of bile acids into the lungs arising from gastro-oesophageal reflux disease (GERD) has since emerged as a host-trigger of chronic bacterial infection (Reen et al, 2012 and chronic inflammation (Legendre et al, 2014), particularly in CF, where up to 40 % of child and 80 % of adult patients can suffer from this complication (Legendre et al, 2014;Pauwels et al, 2012;Reen et al, 2012Reen et al, , 2014Stringer et al, 1988). Indeed, the incidence may be underestimated as clinical diagnosis of GERD is often not sufficient to determine bile aspiration.…”

“…This 'silent aspiration' phenomenon is particularly severe in CF patients and highlights the urgent unmet need for rapid diagnosis of bile acid profiles in biological samples from respiratory and lung transplant patients (Button et al, 2005). In recent years a number of research publications have suggested that acid and non-acid reflux may negatively influence the progression of respiratory disease (D'Ovidio et al, 2005a, b;el-Serag & Sonnenberg, 1997;Pauwels et al, 2012;Perng et al, 2007;Wu, 2008;Wu et al, 2009). El-Serag & Sonnenberg showed that patients with erosive oesophagitis, a sign of significant GERD, had increased incidence of pulmonary fibrosis, chronic bronchitis or chronic obstructive pulmonary disease in a case-control study of more than 200 000 patients (el-Serag & Sonnenberg, 1997).…”

Pregnancy and cystic fibrosis: Approach to contemporary management

“…15,32 Nutritional supplementation via enteral feeding can aggravate gastrooesophageal reflux, which is common in CF, is frequently aggravated by the gravid uterus, and which may exacerbate airway inflammation. [75][76][77] Of the various gastric acid suppressive options, H 2 -blocking therapy (e.g. ranitidine) has the most robust safety profile, but proton pump inhibitors are also likely to be safe.…”

Overexpression of farnesoid X receptor in small airways contributes to epithelial to mesenchymal transition and COX-2 expression in chronic obstructive pulmonary disease

“…Over a long time, gastric acid has been conceived as the dominant toxic agent in GER-associated lung diseases. However, the role of non-acid gastric contents is increasingly recognized in GERD-associated lung diseases (35)(36)(37). Our data indicated that bile acids aspiration may promote airway inflammation via FXR-mediated COX-2 expression, providing a novel insight of the association between GERD and COPD exacerbations.…”