Characteristics of Gastroesophageal Reflux and Potential Risk of Gastric Content Aspiration in Children With Cystic Fibrosis

Blondeau, Kathleen; Pauwels, Ans; Dupont, L J; Mertens, Veerle; Proesmans, Marijke; Orel, Rok; Brecelj, Jernej; López-Alonso, Manuel; Moya, María José; Malfroot, Anne; Wachter, Elke De; Vandenplas, Yvan; Hauser, Bruno; Sifrim, Daniel

doi:10.1097/mpg.0b013e3181acae98

Cited by 81 publications

(80 citation statements)

References 35 publications

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“…Mild to moderate acid exposure from GERD has been implicated in exacerbating respiratory disease and is present in young infants, children and adults with CF; its prevalence ranges from 55 -76% (63,64). Gastroesophageal reflux introduces stomach acid to the oral cavity and depending on its frequency and severity can cause dental injury by eroding dental hard tissues (65).…”

Section: Other Cf--mediated Caries Risk Factorsmentioning

confidence: 99%

Dental utilization for Medicaid‐enrolled children with cystic fibrosis

Sarvas

Huebner

Scott

et al. 2016

Special Care in Dentistry

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Section: Other Cf--mediated Caries Risk Factorsmentioning

confidence: 99%

Dental utilization for Medicaid‐enrolled children with cystic fibrosis

Sarvas

Huebner

Scott

et al. 2016

Special Care in Dentistry

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“…This is particularly prevalent in patients with cystic fibrosis (CF) (2)(3)(4)(5)(6)(7)(8), chronic obstructive pulmonary disease (9), and ventilator-associated pneumonia (10). GER is caused by the leak of stomach contents into the esophagus, which may then lead to aspiration of duodenogastric contents into the respiratory tract.…”

mentioning

confidence: 99%

Bile Acids Repress Hypoxia-Inducible Factor 1 Signaling and Modulate the Airway Immune Response

et al. 2014

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bGastroesophageal reflux (GER) frequently occurs in patients with respiratory disease and is particularly prevalent in patients with cystic fibrosis. GER is a condition in which the duodenogastric contents of the stomach leak into the esophagus, in many cases resulting in aspiration into the respiratory tract. As such, the presence of GER-derived bile acids (BAs) has been confirmed in the bronchoalveolar lavage fluid and sputum of affected patients. We have recently shown that bile causes cystic fibrosis-associated bacterial pathogens to adopt a chronic lifestyle and may constitute a major host trigger underlying respiratory infection. The current study shows that BAs elicit a specific response in humans in which they repress hypoxia-inducible factor 1␣ (HIF-1␣) protein, an emerging master regulator in response to infection and inflammation. HIF-1␣ repression was shown to occur through the 26S proteasome machinery via the prolyl hydroxylase domain (PHD) pathway. Further analysis of the downstream inflammatory response showed that HIF-1␣ repression by BAs can significantly modulate the immune response of airway epithelial cells, correlating with a decrease in interleukin-8 (IL-8) production, while IL-6 production was strongly increased. Importantly, the effects of BAs on cytokine production can also be more dominant than the bacterium-mediated effects. However, the effect of BAs on cytokine levels cannot be fully explained by their ability to repress HIF-1␣, which is not surprising, given the complexity of the immune regulatory network. The suppression of HIF-1 signaling by bile acids may have a significant influence on the progression and outcome of respiratory disease, and the molecular mechanism underpinning this response warrants further investigation.

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“…Reflux episodes seem to underlie coughing in children with CF, rather than being secondary to cough. These children also are at higher risk of aspiration (Blondeau et al 2010). Non-acid reflux episodes are detectable by the pH-impedance method (MII-pH).…”

Section: Introductionmentioning

confidence: 99%

Gastroesophageal Reflux Disease in Children with Cystic Fibrosis

Dziekiewicz

Banaszkiewicz

Urzykowska³

et al. 2015

Advances in Experimental Medicine and Biology

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Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

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Characteristics of Gastroesophageal Reflux and Potential Risk of Gastric Content Aspiration in Children With Cystic Fibrosis

Cited by 81 publications

References 35 publications

Dental utilization for Medicaid‐enrolled children with cystic fibrosis

Dental utilization for Medicaid‐enrolled children with cystic fibrosis

Bile Acids Repress Hypoxia-Inducible Factor 1 Signaling and Modulate the Airway Immune Response

Gastroesophageal Reflux Disease in Children with Cystic Fibrosis

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