Pulmonary aspiration in preschool children with cystic fibrosis

Clarke, Donna; Gorman, I; Ringholz, Fiona; McDermott, Michael; Cox, D.; Greally, Peter; Linnane, Barry; Nally, Paul Mc

doi:10.1186/s12931-018-0954-1

Cited by 6 publications

(6 citation statements)

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“…Aspiration: Recurrent aspiration is the result of anatomical and/or functional abnormalities and it is recognized as a cause or contributing factor of acute and chronic respiratory morbidity in various conditions. [51][52][53][54][55] The anatomical abnormalities consist of direct communications of the tracheobronchial tree and the alimentary tract (such as laryngeal clefts, tracheoesophageal, or bronchoesophageal fistulae) and result in direct aspiration. 12,51,52 Direct aspiration can also result when one or both vocal cords are paralyzed in abduction.…”

Section: Respiratory Pathophysiologymentioning

confidence: 99%

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Koumbourlis

Belessis

Cataletto

et al. 2020

Pediatric Pulmonology

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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on “strong”, “moderate” or “weak” agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long‐term follow‐up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients’ age were also developed.

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Section: Respiratory Pathophysiologymentioning

confidence: 99%

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Koumbourlis

Belessis

Cataletto

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…3. Aspiration : Recurrent aspiration is the result of anatomical and/or functional abnormalities and it is recognized as a cause or contributing factor of acute and chronic respiratory morbidity in various conditions [52][53][54][55][56] . The anatomical abnormalities consist of direct communications of the tracheobronchial tree and the alimentary tract (such as laryngeal clefts, tracheoesophageal or bronchoesophageal fistulae) and result in direct aspiration 12,52,53 .…”

Section: Respiratory Pathophysiologymentioning

confidence: 99%

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Koumbourlis

Belessis

Cataletto

et al. 2020

Preprint

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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Non-invasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.

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“…No statistically significant difference was found among the three saliva samples and the average daily pepsin level in the main group of infants, which may be indicative of latent episodes of reflux during the day. In our opinion, repeated episodes of latent reflux lead to pepsin activation in the cells of the respiratory tract and, as a result, to their damage and the expression Since salivary IL-8 is a cytokine that plays an important role in the pathogenesis of inflammatory and autoimmune diseases, based on the positive association between IL-8 and neutrophil levels in patients with pulmonary diseases [15,16], we concluded that salivary level of IL-8 was significantly higher in the infants with recurrent respiratory pathology. A direct correlation was found between salivary levels of IL-8 and pepsin levels in the main group of children.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Significance of Salivary Pepsin Level in the Development of Recurrent Respiratory Pathology in Infants With Rumination Syndrome

Ilchenko,

Mozheiko,

Fialkovska

2023

EUMJ

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Introduction. Infant rumination syndrome (IRS) is most common among infants with functional disorders of the gastrointestinal tract and can lead to the development of recurrent respiratory pathology. Pepsin is believed to play a key role in the upper airway mucosa impairment. The objective of the study was to determine the prognostic significance of salivary pepsin level in the development of recurrent respiratory pathology in infants with rumination syndrome. Materials and Methods. We analyzed the clinical and anamnestic data of 55 infants: the main group consisted of 38 children with apparent rumination syndrome, and the comparison group included 17 healthy children with no clinical manifestations of this syndrome. Salivary pepsin and IL-8 levels were measured three times a day by the enzyme-linked immunosorbent assay (Human Pepsin Elisa Kit and Human IL-8 ELISA Kit, USA). The study results were statistically processed using the Statistica v.6.1 software package. To assess the diagnostic significance of salivary pepsin level, ROC analysis was performed to determine the optimal cut-off point and calculate the area under the ROC curve (AUC) with 95% CI and operating characteristics of the criterion (sensitivity and specificity). Results and Discussion. Daily monitoring of salivary pepsin in infants showed that pepsin level was significantly higher in the main group vs. the comparison group, both for average daily values and intermediate indicators. No statistically significant difference was found between the three saliva samples and the daily average pepsin level in the main group of infants, which may be indicative of latent episodes of reflux during the day. A direct correlation was found between salivary levels of IL-8 and pepsin levels in the main group of children (r = 0.78, p < 0.05). Among the potential predictors of recurrent respiratory pathology risk in infants with rumination syndrome, the following were established: fasting pepsin level > 309.27 pg/ml, pepsin level in 1 hour after feeding > 275.73 pg/ml, and pepsin level after regurgitation > 532.31 pg/ml. Conclusions. Fasting pepsin level > 309.27 pg/ml and pepsin level in 1 hour after feeding > 275.73 pg/ml can be used in a multiple logistic regression model to predict the risk of recurrent respiratory pathology, taking into account other clinical, anamnestic, and laboratory data. A post-regurgitation pepsin level > 532.31 pg/ml is an independent predictor and can be used alone.

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Pulmonary aspiration in preschool children with cystic fibrosis

Cited by 6 publications

References 10 publications

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

The Prognostic Significance of Salivary Pepsin Level in the Development of Recurrent Respiratory Pathology in Infants With Rumination Syndrome

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