Reflux of gastric juice and glue ear in children

Tasker, Andrea; Dettmar, Peter W.; Panetti, Marguerite; Koufman, James A.; Birchall, John P.; Pearson, J. R. A.

doi:10.1016/s0140-6736(02)07665-1

Cited by 160 publications

(129 citation statements)

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“…Previous studies in children have shown that reflux affects the Eustachian tubes and can lead to an increased risk of otitis media. [5][6][7][8] Bench research has found histological differences in the mucosa of animal Eustachian tubes after contact with gastric acids. [9][10][11] Antireflux therapy has also been found to relieve the chronic refractory feeling of pressure in the ears.…”

Section: Introductionmentioning

confidence: 99%

Nasopharyngeal Acid Reflux and Eustachian Tube Dysfunction in Adults

Brunworth

Mahboubi

Garg

et al. 2014

Ann Otol Rhinol Laryngol

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Objective: This study aimed to evaluate the relationship between nasopharyngeal pH and Eustachian tube dysfunction (ETD) in adults. Study Design: Unmatched case-control study. Methods: Forty-one subjects, 20 adults with a diagnosis of ETD and 21 healthy adults as controls, were enrolled from an outpatient clinic. All subjects had a Dx–pH probe placed near the torus tubarius in the posterior nasopharynx for 24 hours. The pH values were recorded every 0.5 second. Decreases in pH were considered as reflux events if the pH dropped below 5.5. Results: The average nasopharyngeal pH value was 6.90 (range, 5.33-7.73) in the subjects with ETD and 7.07 (range, 5.99-7.94) in the controls. The difference between the 2 groups was not statistically significant ( P = .30). The ETD group, on average, had a higher number of nasopharyngeal reflux events (2.3 ± 1.6 vs 0.8 ± 1.2, respectively; P = .002) and higher reflux finding score (3.6 ± 2.7 vs 0.4 ± 1.4, respectively; P < .001) than the control group. Conclusion: By using a novel pH probe that allows detection of acidity in a nonliquid environment, a comparison of nasopharyngeal pH between control patients and those with ETD was performed. Eustachian tube dysfunction was more likely to be associated with a higher number of nasopharyngeal reflux events and higher reflux finding score. Nasopharyngeal reflux may have a role in the pathogenesis of ETD.

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Section: Introductionmentioning

confidence: 99%

Nasopharyngeal Acid Reflux and Eustachian Tube Dysfunction in Adults

Brunworth

Mahboubi

Garg

et al. 2014

Ann Otol Rhinol Laryngol

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“…18,19,21,33,34 The lower pH in subjects with respiratory disease compared with healthy control subjects is consistent with earlier comparisons between the 2 groups. 16,17,[32][33][34] These lower values for EBC pH in COPD and bronchiectasis may be related to several factors, including airway inflammation, oxidative stress, bacterial colonization, and gastroesophageal reflux. 18,30 The moderate correlations between EBC pH and pepsin concentrations in both bronchiectasis and COPD suggest that in this study sample, gastroesophageal reflux may account for the lower pH observed.…”

Section: Discussionmentioning

confidence: 99%

“…30 Sputum and EBC pepsin concentrations were tested using a locally developed enzyme-linked immunosorbent assay based on a monospecific antibody to porcine pepsin. 11,32 Polystyrene microtiter plates (MaxiSorp, Nunc, Roskilde, Denmark) were coated with goat anti-pepsin antibody, diluted in carbonate-bicarbonate buffer at 0.1 g/mL, and incubated for 4 h. After washing, wells were incubated with a blocking buffer (1% bovine serum albumin) and stored at 4°C overnight. For the assay, wells were washed, and enzyme controls (for standard curve) and clinical samples were added in duplicate.…”

Section: Sputum and Ebc Sample Collectionmentioning

confidence: 99%

Exhaled Breath Condensate Pepsin: Potential Noninvasive Test for Gastroesophageal Reflux in COPD and Bronchiectasis

et al. 2014

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BACKGROUND: Acid gastroesophageal reflux is a common problem in non-cystic fibrosis bronchiectasis and COPD. Invasive methods are used to diagnose gastroesophageal reflux, but the ability to detect pulmonary microaspiration of gastric contents using this method is unclear. A noninvasive option to detect pulmonary microaspiration is to measure pepsin in exhaled breath condensate (EBC), but this has not been related to esophageal pH monitoring in these lung conditions. This study aimed to measure pepsin concentrations and pH in EBC and to determine the relationship to gastroesophageal reflux in bronchiectasis or COPD. METHODS: Subjects with bronchiectasis (n ‫؍‬ 10) or COPD (n ‫؍‬ 10) and control subjects (n ‫؍‬ 10) completed 24-h esophageal pH monitoring for detection of acid gastroesophageal reflux, measuring the percentage of reflux time in the proximal esophagus and the DeMeester score (DMS). Concurrently, 3 samples of EBC were collected from each subject, and pH was measured and pepsin concentrations were analyzed by enzyme-linked immunosorbent assay. RESULTS: EBC pepsin was detected in subjects with bronchiectasis (44%) or COPD (56%) and in control subjects (10%). A diagnosis of gastroesophageal reflux was not associated with a higher concentration of EBC pepsin in bronchiectasis (P ‫؍‬ .21) or COPD (P ‫؍‬ .11). EBC pepsin concentration did not correlate with DMS (r s ‫؍‬ 0.36) or proximal reflux index (r s ‫؍‬ 0.25) in subjects with bronchiectasis or with DMS (r s ‫؍‬ 0.28) or proximal reflux index (r s ‫؍‬ 0.21) in patients with COPD. EBC and sputum pepsin concentrations were moderately correlated in bronchiectasis (r s ‫؍‬ 0.56) and in COPD (r s ‫؍‬ 0.43). CONCLUSIONS: Pepsin is detectable in EBC samples in bronchiectasis and COPD. Although no association was found between pepsin concentrations and a diagnosis of gastroesophageal reflux, a moderate relationship between sputum and EBC pepsin concentrations suggests that EBC pepsin may be a useful noninvasive marker of pulmonary microaspiration.

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“…Many previous studies have suggested an association between LPR and some extra-esophageal syndromes, including OM in pediatrics. [6][7][8][9] In this issue of the Journal of Neurogastroenterology and Motility, Górecka-Tuteja et al 10 described the correlation between LPR and OM in children, and defined LPR by using multichannel intraluminal impedance (MII) combined with dual-probe (pharyngoesophageal) pH-metry (MII/pH). In children, OM is a common cause of acquired hearing loss, and its most important pathophysiology is impaired patency and dysfunction of the Eustachian tube.…”

mentioning

confidence: 99%

“…5 As pepsin and pepsinogen are detected in the OM effusion with a high prevalence as a result of physiologic reflux, whether a causal relationship exists between pepsin/pepsinogen in the OM effusion and OM is unclear. 6 Although it is important to investigate the association between LPR and OM, there is no consensus among guidelines pertaining to LPR diagnosis. 2,14 Therefore, this study is meaningful in its attempt to define LPR using MII/pH.…”

mentioning

confidence: 99%