Importance
The role of aspiration associated extra-esophageal reflux disease (AERD) in patients with chronic respiratory symptoms is not well defined. Identifying the frequency of AERD in these patients may provide us with further guidance in treatment and management of these patients.
Objective
The purpose of this study is to determine the prevalence of AERD in patients with chronic respiratory symptoms compared to controls and, secondly, to assess the utility of pepsin as a new marker for AERD.
Design
Case-control study performed from 2008-2012.
Setting
Tertiary referral center.
Participants
Patients (4.5 months-24 years) with chronic pulmonary disease, both with and without tracheostomy, were compared to controls with no prior history of pulmonary disease undergoing elective surgery.
Interventions: Lavage fluid specimen was obtained from each participant.
Main Outcome Measures
Western blot analysis for pepsin and oil red O staining for lipid-laden macrophages (LLM) was performed on lavage fluid specimens to assess for AERD.
Results
Seventy-six total patients were enrolled: 65 study patients, of which, 34 patients underwent bronchoscopy, 31 patients had tracheostomy for sampling, and 11 controls. Pepsin positive lavage fluid specimens were identified in 25 (74%) bronchoscopy patients and 22 (71%) tracheostomy patients. All control specimens were negative for pepsin. Presence of LLM was identified in 91% of bronchoscopy group, 52% of tracheostomy patients, and 64% of controls, with a similar distribution of the quantity of LLM in each lavage fluid specimen amongst the groups.
Conclusions and Relevance
Patients with chronic pulmonary disease have a high prevalence of AERD, which may have important treatment implications. The presence of pepsin was a better predictor of AERD in patients with respiratory symptoms compared to controls than LLM. Detection of pepsin in BAL can serve as a biomarker for AERD and is potentially superior to the current method of measuring LLM. While there is a significant association among patients with AERD and those patients with chronic respiratory symptoms, this study does not verify causation. Additional study investigating the mechanism of pepsin on the respiratory epithelium may provide further understanding of the pathophysiology of this association and provide additional management options for these patients.