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Canadian Respiratory Journal
Volume 2016, Article ID 9480843, 7 pages
http://dx.doi.org/10.1155/2016/9480843
Research Article

Clinical Utility of Bronchoalveolar Lavage Pepsin in Diagnosis of Gastroesophageal Reflux among Wheezy Infants

1Gastroenterology and Hepatology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
2Allergy, Respiratory, and Clinical Immunology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
3Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
4Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt

Received 20 February 2016; Accepted 19 June 2016

Academic Editor: Christophe Leroyer

Copyright © 2016 Ahmed Fathi Abdallah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing. Objectives. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants. Methods. Fifty-two wheezy infants were evaluated for GERD using esophageal combined impedance-pH (MII-pH) monitoring, esophagogastroduodenoscopy with esophageal biopsies, and BAL pepsin. Tracheobronchial aspirates from 10 healthy infants planned for surgery without history of respiratory problems were examined for pepsin. Results. Wheezy infants with silent reflux and wheezy infants with typical GERD symptoms but normal MII-pH had significantly higher BAL pepsin compared to healthy control (45.3 ± 8.6 and 42.8 ± 8 versus 29 ± 2.6, and , resp.). BAL pepsin had sensitivity (61.7%, 72 %, and 70%) and specificity (55.5%, 52.9%, and 53%) to diagnose GERD associated infantile wheeze compared to abnormal MII-pH, reflux esophagitis, and lipid laden macrophage index, respectively. Conclusion. A stepwise approach for assessment of GERD in wheezy infants is advised. In those with silent reflux, a trial of antireflux therapy is warranted with no need for further pepsin assay. But when combined MII-pH is negative despite the presence of typical GERD symptoms, pepsin assay will be needed to rule out GERD related aspiration.