Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux–related pulmonary aspiration

Farrell, Stephen W.; McMaster, Cyril; Gibson, David; Shields, Michael; McCallion, W. A.

doi:10.1016/j.jpedsurg.2005.11.002

Cited by 142 publications

(107 citation statements)

References 11 publications

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“…Additional modifications of our laboratory procedures to detect lower levels of amylase are warranted; however, the values we obtained were similar to those reported for patients receiving mechanical ventilation who had risk factors for aspiration and infections. 5,7,8 Our findings are consistent with those of other reports 5,6,[8][9][10][11][12]14,[26][27][28][29][30][31][32][33][34][35][36] of pepsin and amylase as biomarkers of microaspiration. Dewavrin and colleagues 36 argue that the use of amylase is only moderately accurate in diagnosing microaspiration.…”

Section: Discussionsupporting

confidence: 92%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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worth, RN, MSN, CCRN, CCNS, and Devendra Indulal Mehta, MBBS, MSc(dist), MRCP Background Endotracheal intubation increases the risk for microaspiration of secretions around the tube cuff. Pepsin has been used as a biomarker for gastric aspiration. Amylase is a newer proposed biomarker for aspiration of oral contents. Objective To assess the presence of pepsin and amylase in paired oral-tracheal secretions of adult patients treated with mechanical ventilation. Methods In this descriptive study, paired samples of oral and tracheal secretions were obtained from adult patients at baseline and again within 4 hours when a need for endotracheal suctioning was assessed. Assays of pepsin and amylase were processed in a specialty diagnostic laboratory. Results The sample consisted of 10 men and 3 women with a median age of 56 years. The majority were intubated with a subglottic suction endotracheal tube (9 patients, 69%), receiving synchronized intermittent mandatory ventilation (10 patients; 77%), and receiving enteral feedings (11 patients; 85%) through a tube distally placed in the stomach (8 patients; 67%). Pepsin was present in oral secretions of 9 patients (69%), and in tracheal specimens of 7 patients (54%) at one or both sampling times. Amylase was detected in all patients' oral secretions and in tracheal secretions of 5 patients (38%) at one or both sampling times. Conclusions Many patients had pepsin, amylase, or both in tracheal aspirates. Pepsin was more commonly detected than was amylase. Although the relationship of this finding to longterm outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.

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Section: Discussionsupporting

confidence: 92%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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“…5 Thus, the detection of the above substances in BAL has been considered overall as a strong confirmation of gastric contents coming up from the stomach into the airways. Ozdemir et al 1 stated that BAL pepsin levels have been studied very poorly to diagnose gastroesophageal reflux (GERD) in patients with respiratory symptoms and quote the only investigation by Decalmer et al, 6 in which the authors found in controls lower levels of pepsin than those detected in chronic cough patients.…”

Section: 4mentioning

confidence: 99%

Relevance of Measuring Substances in Bronchoalveolar Lavage Fluid for Detecting Aspiration-associated Extraesophageal Reflux Disease

Savarino

Zentilin

Marabotto

et al. 2017

J Neurogastroenterol Motil

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“…Interestingly, the highly specific and sensitive method for diagnosing GER -associated with respiratory tract aspiration is measurement of pepsin level in BAL. Since the gold-standard for diagnosis of microaspiration remains undetected, so the assessment of pepsin and bile salt presence to the gastrointestinal tract makes this diagnostic technique incredibly attractive [13]. In general, adjusting the response of fibrogenesis after the injury is used mainly for recent treatment in IPF, not on prevention of injury itself.…”

Section: Introductionmentioning

confidence: 99%

“…Bronchoscopy was done with patients in a semi recumbent position through the nasal route. Oxygen supply was given and oxygen saturation monitored by oximetry [13]. Instillations of at least 100 ml of sterile saline were done in a sub-segment of the right middle lobe or lingual for performing BAL.…”

mentioning

confidence: 99%

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

Said¹,

Alsowey²,

Ibraheem³

2017

Zagazig University Medical Journal

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Background: Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause.Recently, there is increasing evidence supporting a relationship between gastroesophageal reflux, microaspiration, and IPF, since the diagnostic gold-standard for microaspiration remains unknown. So, the aim of this study is to assess the presence of chronic microaspirates by bronchoalveolar lavage pepsin level in these patients. Patients and method: A case -control study was conducted at Chest Department and outpatient clinics Faculty of Medicine, Zagazig University hospitals in the period from (February 2013 till January 2016) on thirty patients with stable interstitial lung diseases (ILD).they were divided into two groups: 15 patients (group I) with stable idiopathic pulmonary fibrosis (IPF), another 15 patients (group II) stable ILD other than IPF. Both groups underwent pulmonary function tests (PFTs), Pulmonary HRCT and Bronchoscopy. Measurement of bronchoalveolar lavage pepsin level was done for all patients. Results: 80% of IPF patients complained from gastroesophageal reflux with a statistically significant decrease in PaO 2 , FEV 1 and FVC than in non IPF patients.Bronchoalveolar lavage pepsin level was (43.711.4ng/ml) in IPF group, which was significantly higher than non IPF group (32.710.5 ng/ml).Also total cell count in IPF patients were increased significantly including neutrophils, alveolar macrophages and red blood. Increased reticulation on HRCT for IPF patients group were associated with higher BAL pepsin levels (p <0.01). Regression coefficient revealed the most powerful predictor of IPF severity were; HRCT findings: reticulation score,honeycombing score[(Odds ratio(95%CI)=5.3 (1.9 to14.9), 7.8 (2.7 to 22.3)respectively],pepsin level[(Odds ratio(95%CI)=4.6 (1.9-11.4)],FEV1 and FVC[(Odds ratio(95%CI)=3.7 (1.6 to 8.9), 3.2 (1.4 to 7.5)respectively].while gastroesophageal reflux symptom [(Odds ratio(95%CI)=1.04(0.94-1.14)] was the least powerful predictor. Conclusion: Gastroesophageal reflux or microaspiration is common in patients with IPF, associated with elevated levels of pepsin in BAL fluid.

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Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux–related pulmonary aspiration

Abstract: This study suggests that GOR-related aspiration plays a role in chronic cough in children with known GOR. Detecting pepsin in BAL fluid may therefore become an important adjunct in patient selection for antireflux surgery.

Cited by 142 publications

References 11 publications

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Relevance of Measuring Substances in Bronchoalveolar Lavage Fluid for Detecting Aspiration-associated Extraesophageal Reflux Disease

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

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