Bronchial reacutization and gastroesophageal reflux: is there a potential clinical correlation?

Abstract

Background: Pepsin plays a role in gastroesophageal reflux (GER). Aims of this study were to verify if pepsin could be the cause of frequent bronchial exacerbations and to check if the persistence of chronic respiratory symptoms were correlated with pre-existing respiratory diseases.

Methods: From January to May 2016, 42 patients underwent a diagnostic bronchoscopy. All patients had a history of at least one bronchial exacerbation during the previous year. Bronchial lavage fluid specimens were obtained. A semiquantitative assessment of pepsin in the samples was carried out based on the intensity of the test sample.

Results: Pepsin was present in 37 patients (88%), but in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD), the finding of pepsin in the bronchoalveolar fluid was 100%. There was a strong positive statistical correlation between pepsin detection and radiological signs of GER (ρ=0.662), and between pepsin detection and diagnosis (ρ=0.682). No correlation was found between the bacteriology and the presence of pepsin in the airways (ρ=0.006).

Conclusions: The presence of pepsin in the airways shows the occurrence of reflux. The persistence of respiratory symptoms by at least 2 months suggest an endoscopic bronchial examination. This straightforward test confirms the cause possible irritation of the airways and may prevent further diagnostic tests, such as an EGD or pH monitoring esophageal.

Keywords: Bronchial reacutization; bronchoscopy; gastroesophageal reflux (GER); pepsin.

Figure 1

Fiberoptic bronchoscopy for the detection of the gastric pepsin (Pep-test) (10). The main risk of pepsin detection in bronchial secretions is the sucking of the salivary secretions. Secretions enter in the bronchial tree during the anaesthesia of the vocal cords and the tracheal introduction of the bronchoscope. It is necessary to standardise the procedure to reduce this risk: (I) perform an abundant nasal local anaesthetic (Lidocaine spray 10% in aqueous solution), not in the larynx; (II) insert the bronchoscope into the trachea slowly and, if possible, not introduce anaesthetic into the trachea; (III) proceed aspiration supporting the tip of the instrument on the front wall of trachea; (IV) if the specimen is not significant, wash the saline into the trachea and aspire in the middle and lower lobe and then repeat the manoeuvre on the left side; (V) after the Pep-test, complete the exam with Bronchoalveolar lavage for bacteriological examination. Available online: http://www.asvide.com/articles/1119

Figure 2

Pep-test. A semiquantitative assessment of pepsin was carried out based on the intensity of the test sample (line T compared to the control line C).