title: Correlation between laryngobronchoscopy and pepsin in the diagnosis of extra-oesophageal reflux.
abstract: OBJECTIVE
  This study aimed to investigate pepsin as a marker of extra-oesophageal reflux disease by examining its presence in tracheal aspirates and correlating it with macroscopic changes on laryngobronchoscopy, along with the results of standard tests for gastro-oesophageal reflux disease and clinical features.
  
  
  METHODS
  A retrospective review was undertaken of a cohort of 188 paediatric patients who underwent laryngobronchoscopy at a tertiary children's hospital and for whom pepsin assay results of tracheal aspirates were available. An association analysis was performed.
  
  
  RESULTS
  The mean patient age was 3.99 (3.40-4.58) years, with a male preponderance (55 per cent). Positive changes on laryngobronchoscopy were significantly associated with positive tracheal pepsin findings (p < 0.0001) but not with positive standard gastro-oesophageal reflux disease investigations. A positive pepsin assay was significantly associated with a history of recurrent croup (p = 0.0385) and a diagnosis of cystic fibrosis (p = 0.0232).
  
  
  CONCLUSIONS
  Macroscopic changes on laryngobronchoscopy were significantly associated with positive tracheal pepsin findings in this paediatric population, suggesting that extra-oesophageal reflux disease may be a contributing aetiology.
authors.affiliation: Department of Paediatric Gastroenterology,Sydney Children's Hospital,Sydney,Australia.
authors.forename: U
authors.initials: U
authors.lastname: Krishnan
authors.affiliation: School of Women's and Children's Health,University of New South Wales,Sydney,Australia.
authors.forename: S
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Paediatric Gastroenterology,Sydney Children's Hospital,Sydney,Australia.
authors.forename: I
authors.initials: I
authors.lastname: Messina
authors.affiliation: Department of Paediatric Otolaryngology Head and Neck Surgery,Sydney Children's Hospital,Sydney,Australia.
authors.forename: M
authors.initials: M
authors.lastname: Soma
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001999:Bronchoscopy / Q000379:methods*; D002675:Child, Preschool; D003440:Croup / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D003937:Diagnosis, Differential; D004947:Esophagus / Q000378:metabolism / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D010434:Pepsin A / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D010434:Pepsin A
keywords: Bronchoscopy; Croup; Gastroesophageal Reflux; Laryngoscopy; Pepsin