title: Pepsin and bile acid concentrations in sputum of mustard gas exposed patients.
abstract: OBJECTIVE
  Gastro-esophageal reflux has been suggested to be associated with several pulmonary complications such as asthma, and post-transplant bronchiolitis obliterans (BO). Pepsin or bile salts in the sputum is shown to be an optimal molecular marker of gastric contents macro/micro aspiration. In this study, we investigated sputum pepsin as a marker of micro-aspiration in sulfur mustard (SM) exposed cases compared to healthy controls.
  
  
  METHODS
  In a case controlled study, 26 cases with BO and 12 matched healthy controls were recruited and all cases were symptomatic and their exposure to SM was previously documented during Iran-Iraq conflict. Pepsin levels in sputum and total bile acids were measured using enzymatic assay. The severity of respiratory disorder was categorized based upon the spirometric values.
  
  
  RESULTS
  The average concentration of pepsin in sputum was higher in the case group (0.29 ± 0.23) compared with healthy subjects (0.13 ± 0.07; P ± 0.003). Moreover, the average concentration of bile acids in the sputum cases was not significantly different in comparison to the controls ( P = 0.5).
  
  
  CONCLUSIONS
  Higher pepsin concentrations in sputum of SM exposed patients compared with healthy control subjects indicate the occurrence of significantly more gastric micro-aspiration in SM exposed patients.
authors.affiliation: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Karbasi
authors.forename: Hassan
authors.initials: H
authors.lastname: Goosheh
authors.forename: Rasoul
authors.initials: R
authors.lastname: Aliannejad
authors.forename: Hamid
authors.initials: H
authors.lastname: Saber
authors.forename: Maryam
authors.initials: M
authors.lastname: Salehi
authors.forename: Mahvash
authors.initials: M
authors.lastname: Jafari
authors.forename: Saber
authors.initials: S
authors.lastname: Imani
authors.forename: Amin
authors.initials: A
authors.lastname: Saburi
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ghanei
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology; D016022:Case-Control Studies; D002618:Chemical Warfare; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009151:Mustard Gas / Q000009:adverse effects*; D010434:Pepsin A / Q000032:analysis*; D013183:Sputum / Q000737:chemistry*
chemical_list: D001647:Bile Acids and Salts; D015415:Biomarkers; D002619:Chemical Warfare Agents; D010434:Pepsin A; D009151:Mustard Gas