Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Feb;39(2):352-8.
doi: 10.1183/09031936.00050911. Epub 2011 Dec 19.

Bronchoalveolar lavage pepsin in acute exacerbation of idiopathic pulmonary fibrosis

J S Lee  1 , J W Song, P J Wolters, B M Elicker, T E King Jr, D S Kim, H R Collard
Affiliations

Bronchoalveolar lavage pepsin in acute exacerbation of idiopathic pulmonary fibrosis

J S Lee et al. Eur Respir J. 2012 Feb.

Abstract

Some patients with idiopathic pulmonary fibrosis experience acute exacerbations in their respiratory status leading to substantial morbidity and mortality. Occult aspiration of gastric contents has been proposed as one possible mechanism leading to these acute exacerbations. We sought to determine whether pepsin, a marker of gastric aspiration, is elevated in bronchoalveolar lavage fluid obtained from patients during acute exacerbation of idiopathic pulmonary fibrosis, compared with that obtained in stable disease. Lavage samples were obtained in a case-control study of well-characterised patients. Acute exacerbation was defined using standard criteria. Levels of lavage pepsin were compared in cases and controls, and were correlated with clinical features and disease course. 24 cases with acute exacerbations and 30 stable controls were identified. There were no significant differences in baseline demographics between the two groups. Pepsin level was an indicator of acute exacerbation status (p=0.04). On average, pepsin appeared higher in patients with acute exacerbations compared with stable controls. This difference was driven by a subgroup of eight patients (33%) with pepsin levels ≥70 ng·mL(-1). Pepsin level was not an independent predictor of survival time. These results suggest occult aspiration may play a role in some cases of acute exacerbation of idiopathic pulmonary fibrosis.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Bronchoalveolar lavage (BAL) pepsin levels in patients with stable idiopathic pulmonary fibrosis (IPF) compared with acute exacerbation of IPF. Horizontal lines represent median, 25th percentile and 75th percentile.
FIGURE 2
FIGURE 2
Bronchoalveolar lavage (BAL) pepsin levels in seven patients with matched stable and acute exacerbation of idiopathic pulmonary fibrosis BAL samples. Each line represents one study subject. The closed circles and solid line represent the subject who had a high BAL pepsin level during the acute exacerbation. The open circles and dashed lines represent those subjects who had low BAL pepsin levels during their acute exacerbations.
FIGURE 3
FIGURE 3
Correlation between bronchoalveolar lavage (BAL) pepsin levels and % predicted total lung capacity (TLC).
See this image and copyright information in PMC

Comment in

References

    1. Raghu G, Weycker D, Edelsberg J, et al. Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2006;174:810–816. - PubMed
    1. Bjoraker JA, Ryu JH, Edwin MK, et al. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;157:199–203. - PubMed
    1. King TE, Jr, Tooze JA, Schwarz MI, et al. Predicting survival in idiopathic pulmonary fibrosis: scoring system and survival model. Am J Respir Crit Care Med. 2001;164:1171–1181. - PubMed
    1. Collard HR, Moore BB, Flaherty KR, et al. Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2007;176:636–643. - PMC - PubMed
    1. Kim DS, Park JH, Park BK, et al. Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features. Eur Respir J. 2006;27:143–150. - PubMed

Publication types