title: Clinical Utility of Bronchoalveolar Lavage Pepsin in Diagnosis of Gastroesophageal Reflux among Wheezy Infants.
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, P < 0.0001 and P = 0.011, 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.
authors: Gastroenterology and Hepatology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors: Ahmed Fathi
authors: AF
authors: Abdallah
authors: Allergy, Respiratory, and Clinical Immunology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors: Tarek
authors: T
authors: El-Desoky
authors: Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors: Khalid
authors: K
authors: Fathi
authors: Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors: Wagdy Fawzi
authors: WF
authors: Elkashef
authors: Allergy, Respiratory, and Clinical Immunology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors: Ahmed
authors: 0000-0001-6359-5572
authors: A
authors: Zaki
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D016022:Case-Control Studies; D002675:Child, Preschool; D015331:Cohort Studies; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D010434:Pepsin A / Q000032:analysis*; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity
chemical_list: D010434:Pepsin A