Airway inflammation and injury in children with prevalent weakly acidic gastroesophageal refluxes

Sacco, Oliviero; Silvestri, Michela; Ghezzi, Michele; Capizzi, Antonino; Rossi, Giovanni A.

doi:10.1016/j.rmed.2018.08.011

Cited by 13 publications

(12 citation statements)

References 43 publications

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“…30,31 In children, both strongly and weakly acidic chemical insults resulted in increased BAL fluid neutrophils and increased lymphocytes, indicating a nonspecific response to airway injury. 32 It is unclear why some dogs in our study developed mixed inflammation rather than purely lymphocytic inflammation, but it might reflect a disease process more similar to aspiration pneumonitis in some dogs versus the neutrophilic response of aspiration pneumonia in other dogs.…”

Section: Discussionmentioning

confidence: 80%

“…Aspiration injury is thought to trigger a Th17 response as part of the immune response to inhalation of pathogens or irritant material, and microaspiration has been proposed to play an important role in a number of respiratory diseases in dogs . In children, both strongly and weakly acidic chemical insults resulted in increased BAL fluid neutrophils and increased lymphocytes, indicating a nonspecific response to airway injury . It is unclear why some dogs in our study developed mixed inflammation rather than purely lymphocytic inflammation, but it might reflect a disease process more similar to aspiration pneumonitis in some dogs versus the neutrophilic response of aspiration pneumonia in other dogs.…”

Section: Discussionmentioning

confidence: 99%

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Bronchoalveolar lavage fluid lymphocytosis in 104 dogs (2006‐2016)

Johnson

Vernau

2019

Veterinary Internal Medicne

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Background Bronchoalveolar lavage (BAL) fluid cytology and culture are used to characterize respiratory diseases in dogs. Little is known about disorders associated with increased numbers of lymphocytes in BAL fluid. Objective To evaluate duration of clinical signs and detection of specific respiratory diagnoses in dogs with BAL lymphocytosis. Animals One‐hundred four client‐owned dogs evaluated for respiratory signs. Methods Medical records of dogs that had >300 cells/μL and >20% lymphocytes on a differential cell count of BAL fluid between January 1, 2006, and January 1, 2016, were reviewed retrospectively. Cases were evaluated for the duration of clinical signs and respiratory diagnoses, including aspiration injury, infectious or inflammatory respiratory disease, and airway collapse. Results Dogs ranged in age from 0.5 to 16 years (median, 7.9 years) and had a median body weight of 11.4 kg (range, 2.0‐42.7 kg). Eosinophilic lung disease was documented in 13 of 104 dogs (Group 1) and airway neutrophilia associated with infectious or inflammatory disease was found in 59 of 104 dogs (Group 2). Lymphocytosis alone in BAL fluid was described in 32 dogs (Group 3). Duration of cough did not differ among groups, but airway collapse was significantly more common in dogs with solitary lymphocytosis than in those with other types of inflammation. Conclusions and Clinical Importance Lymphocytosis in BAL fluid is common in dogs and, in many cases, likely represents a common response to airway injury, independent of the type or duration of insult. It is unknown whether airway collapse leads to lymphocytosis or if the inflammatory process causes airway collapse.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Bronchoalveolar lavage fluid lymphocytosis in 104 dogs (2006‐2016)

Johnson

Vernau

2019

Veterinary Internal Medicne

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“…BAL was performed by injecting 3×1 ml/kg body weight aliquots of sterile saline solution, which were aspirated at a negative pressure of 40mm Hg in siliconized plastic tubes. Samples of BAL fluid was sent to the laboratory for microbiologic and cytologic examination and total and differential cell counts were recorded as described [10]. Bacterial growth was expressed as colony-forming units (CFU)/mL.…”

Section: Fiberoptic Bronchoscopy and Bronchoalveolar Lavage (Bal)mentioning

confidence: 99%

Is secondary tracheomalacia associated with persistent lower respiratory tract inflammation and subclinical infection?

Capizzi¹,

Silvestri²,

Rossi³

et al. 2020

Preprint

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Background. In secondary tracheomalacia due to mediastinal vascular anomalies one of the most prevalent symptom is recurrent lower respiratory tract (LRT) infections, related to defective airway clearance. Whether this condition could result in persistent LRT inflammation and subclinical infection is not known. Patients and methods. Children with tracheomalacia due to mediastinal vascular anomalies, recurrent (>3/y) LRT infections were evaluated while in stable condition. Computed tomography (CT) scan and bronchoscopy with bronchoalveolar lavage (BAL) were performed. Results. 31 children were included in the study: 21 with aberrant innominate artery (AIA), 4 with right aortic arch (RAA) and 1 with double aortic arch (DAA) and 5 with AIA associated with RAA. Cytological evaluation of BAL fluid showed increased neutrophil percentages and normal lymphocyte and eosinophil proportions. Microorganism growth was detected in 35.5% of BAL samples, with a bacterial load >105 colony-forming-units (CFU)/mL only in 10,2% of them. Most isolates were positive for Haemophilus influenzae, followed by Streptococcus pneumoniae, Group A β-hemolytic streptococci and Moraxella catarrhalis. Chest CT scan demonstrated the presence of bronchiectasis in 13% of the children, of which only one had a positive BAL culture for Haemophilus influenzae. Conclusions. Only in a small subgroup of children, persistent neutrophilic alveolitis was associated with a significant bacterial load and the presence of bronchiectasis. Because most pathogens detected in BAL samples cultures can produce biofilms, caution should be used in inappropriate antibiotic prescription in these patients that, chiefly in those with bronchiectasis, in which chest physiotherapy can be of great benefit.

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“…In addition, this type of medication can provoke constipation or diarrhea. When antacid medication is unsuccessful after a few weeks, the physician may recommend medication that reduce the gastric juice production, without any side effects, also curing the inflammation of the mucosa, although it reacts slower than the antacid medication.Prokinetic medicationis also useful in the treatment of GERD strengthening the lower esophageal sphincter, emptying the stomach faster, and tightening the valve between the stomach and the esophagus [16][17][18][19]21].…”

Section: Symptoms and Treatment Of Gastroesophageal Refluxmentioning

confidence: 99%

Gastroesophageal Reflux and Wheezing in Pediatry pH-metry studies

Elisei¹,

Tutunaru²,

Grigore³

et al. 2019

Rev. Chim.

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Analysis of esophageal pH is useful and recommended by specialists when the gastroesophageal reflux disease does not show specific symptoms such as chest pain or burnings, but a form of asthma and chronic cough. The investigation is performed after a mild anesthesia, inserting a thin and flexible catheter in the patient�s nostril; it reaches the esophagus, particularly the esophageal sphincter that connects the stomach to the esophagus. The catheter has a sensor that monitors the acidity level, the number of reflux episodes, their duration and the part of the esophagus reached by the acid in the stomach. Gastroesophageal reflux disease is frequently met in pediatric practice, rooting in the intrauterine life, a physiologic phenomenon in infants during the first semester of life.

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Airway inflammation and injury in children with prevalent weakly acidic gastroesophageal refluxes

Abstract: In this patient population, WAR events can be associated with a significant airway inflammation and injury that, because of the biochemical mechanisms involved, are likely not completely preventable and/or counteracted by anti-acid treatments.

Cited by 13 publications

References 43 publications

Bronchoalveolar lavage fluid lymphocytosis in 104 dogs (2006‐2016)

Bronchoalveolar lavage fluid lymphocytosis in 104 dogs (2006‐2016)

Is secondary tracheomalacia associated with persistent lower respiratory tract inflammation and subclinical infection?

Gastroesophageal Reflux and Wheezing in Pediatry pH-metry studies

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