A putative link between pertussis and new onset of gastroesophageal reflux an observational study

Abstract

Background: Pertussis is an infectious disease of the respiratory tract with a changing epidemiology. An increasing incidence has been found in the adult population with recurrent infections possibly related to changes in the current vaccine. Is there an association between pertussis infection, refractory cough and atypical gastro-oesophageal reflux (GORD)? Does this magnify and compound respiratory complications?

Methods: Observational study which compares post-pertussis (n=103) with non-pertussis patients (n=105) with established GORD. Patients were assessed for laryngopharyngeal reflux and aspiration of refluxate by a novel scintigraphic study.

Results: Both groups showed severe GORD in association with high rates of laryngopharyngeal reflux (LPR) and pulmonary aspiration and lung disease. High rates of hiatus hernia and clinical diagnosis of "atypical" asthma showed correlations with pulmonary aspiration.

Conclusions: A high level of new onset LPR and lung aspiration has been shown in patients with chronic cough after recent pertussis infection by a novel scintigraphic technique with fused hybrid x-ray computed tomography (SPECT/CT).

Keywords: GORD; aspiration; asthma; hiatus hernia; laryngopharyngeal; scintigraphy.

Figure 1.

Graph showing rates of pertussis infection in Australia. A significant fall occurs in the early 1940s after institution of whole-cell vaccines. Following the change to the acellular vaccines in the 1970s, there is a progressive rise which peaks in 2012 and remains relatively high.

Figure 2.

A) Coronal images from a low-dose SPECT/CT study of the lungs which shows significant retention of refluxate in the oesophagus (arrowheads) and refluxate located in the main bronchi (arrows). B) High-resolution transaxial CT images of the chest showing a combination of mosaic attenuation (arrows) and cystic bronchiectasis (arrowheads).

Figure 3.

The low-dose SPECT/CT images of the head and neck in the sagittal and transaxial planes with fusion images show refluxate contaminating the laryngopharynx (LPR), nasopharynx (NP), nasal turbinates (NT) and the left maxillary sinus. Significant soft tissue thickening is apparent in the left maxillary sinus.

Figure 4.

Fused images from a low-dose SPECT/CT image of the head and neck demonstrates significant retention of refluxate in the oesophagus, consistent with ineffective clearance and contamination of the main bronchi in both lungs.

Figure 5.

Graphical analysis of liquid gastric emptying with data from the supine study showing significant prolongation in emptying with a time to half clearance of 69.2 minutes.