RT Journal Article
SR Electronic
T1 Lipid laden macrophages in bronchoalveolar lavage as a marker of pulmonary aspiration secondary to acid and non-acid gastroesophageal reflux
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4468
VO 44
IS Suppl 58
A1 Jayakumar Mahalingam Arumugam
A1 Caroline Hartt
A1 Babu Vadamalayan
A1 Theodore Patel
A1 Hizbullah Shaikh
A1 Gary Ruiz
A1 Atul Gupta
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P4468.abstract
AB Background:Gastroesophageal reflux (GOR) is known to cause and exacerbate respiratory problems. Presence of lipid-laden macrophages (LLM) in the airways is postulated as a marker of aspiration. However, little is known about the relationship of bronchoalveolar lavage (BAL) LLM and acid/non-acid GOR. Aim:To assess the relationship between acid/non-acid GOR measured by pH/impedance study and BAL LLM in children with respiratory problems. Method:Prospective data from 53 children who underwent flexible bronchoscopy, BAL and pH/impedance study on the same day between January 2010 and October 2013 were analysed. LLM scoring was done using Colombo index. A scatter plot and linear regression analysis were used to assess the correlation between reflux detected by pH study and percentage of LLM. Results:The cohort consisted of patients with chronic cough(n= 22),cystic fibrosis(n= 16) and difficult asthma(n= 15). 41 of these children had oesophageal pH study and 12 had impedance study. There was significant but weak positive correlation between LLM index in BAL and duration of acid reflux measured by pH study (Pearson's correlation coefficient=0.14; Spearman's rank = 0.35). BAL LLM as a marker of aspiration as indicated by pH study has a sensitivity of 87.5% (95% CI: 61.62% to 98.08%) and a specificity of 28% (95% CI: 12.12% to 49.39%). The same as indicated by impedance study has a sensitivity of 75% (95% CI: 20.34% to 95.88%) and a specificity of 50% (95% CI: 16.01% to 83.99%). Conclusion:In detecting acidic and non-acidic GOR related pulmonary aspiration in children with respiratory problems, LLM scoring in BAL has poor specificity and sensitivity.