title: Bronchoalveolar lavage pepsin in acute exacerbation of idiopathic pulmonary fibrosis.
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.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.forename: J W
authors.initials: JW
authors.lastname: Song
authors.forename: P J
authors.initials: PJ
authors.lastname: Wolters
authors.forename: B M
authors.initials: BM
authors.lastname: Elicker
authors.forename: T E
authors.initials: TE
authors.lastname: King
authors.forename: D S
authors.initials: DS
authors.lastname: Kim
authors.forename: H R
authors.initials: HR
authors.lastname: Collard
mesh_terms: D000208:Acute Disease; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000378:metabolism* / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010434:Pepsin A / Q000032:analysis / Q000378:metabolism*; D011237:Predictive Value of Tests; D011859:Radiography; D053120:Respiratory Aspiration / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000401:mortality*; D016019:Survival Analysis
chemical_list: D010434:Pepsin A