Bronchial reacutization and gastroesophageal reflux: is there a potential clinical correlation?
BACKGROUND
Pepsin plays a role in gastroesophageal reflux (GER). Aims of this study were to verify if pepsin could be the cause of frequent bronchial exacerbations and to check if the persistence of chronic respiratory symptoms were correlated with pre-existing respiratory diseases.


METHODS
From January to May 2016, 42 patients underwent a diagnostic bronchoscopy. All patients had a history of at least one bronchial exacerbation during the previous year. Bronchial lavage fluid specimens were obtained. A semiquantitative assessment of pepsin in the samples was carried out based on the intensity of the test sample.


RESULTS
Pepsin was present in 37 patients (88%), but in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD), the finding of pepsin in the bronchoalveolar fluid was 100%. There was a strong positive statistical correlation between pepsin detection and radiological signs of GER (ρ=0.662), and between pepsin detection and diagnosis (ρ=0.682). No correlation was found between the bacteriology and the presence of pepsin in the airways (ρ=0.006).


CONCLUSIONS
The presence of pepsin in the airways shows the occurrence of reflux. The persistence of respiratory symptoms by at least 2 months suggest an endoscopic bronchial examination. This straightforward test confirms the cause possible irritation of the airways and may prevent further diagnostic tests, such as an EGD or pH monitoring esophageal.
Thoracic Endoscopy Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Carlo
C
Pomari
Laboratory Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Luisa
L
Mauroner
Thoracic Endoscopy Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Simona
S
Paiano
Thoracic Endoscopy Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Luca Rosario
LR
Assante
Thoracic Surgery Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Luca
L
Bertolaccini
Division of General Surgery, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Giacomo
G
Ruffo
Radiological Department, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Paride
P
Mainardi
Digestive Endoscopy Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Paolo
P
Bocus
Intestinal Bowel Disease Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Andrea
A
Geccherle
Otolaryngology-Head and Neck Surgery, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Sergio Ivan
SI
Albanese
Laboratory Unit, Sacro Cuore Don Calabria Hospital - Cancer Care Center, Negrar Verona, Italy.
Stefano
S
Ciaffoni
Bronchial reacutization; bronchoscopy; gastroesophageal reflux (GER); pepsin
BMC Pulm Med. 2013 Aug 09;13:51
23927016
Eur Respir J. 2013 Nov;42(5):1322-31
23471347
Laryngoscope. 2012 Jun;122(6):1312-6
22447277
Lancet. 1986 Feb 8;1(8476):307-10
2868172
Balkan Med J. 2015 Jan;32(1):46-50
25759771
J Pediatr Gastroenterol Nutr. 2002 Sep;35(3):303-8
12352517
Ann Otol Rhinol Laryngol. 2010 Mar;119(3):203-8
20392035
Gastroenterology. 1996 Jun;110(6):1982-96
8964428
AJR Am J Roentgenol. 2010 Apr;194(4):972-6
20308499
Int J Otolaryngol. 2012;2012:646901
22242022
Am J Gastroenterol. 2006 Aug;101(8):1900-20; quiz 1943
16928254
Curr Opin Gastroenterol. 2010 Jul;26(4):389-94
20473157
Gastrointest Endosc Clin N Am. 2005 Apr;15(2):319-31
15722244
J Thorac Cardiovasc Surg. 2001 Sep;122(3):430-9
11547291
JAMA Otolaryngol Head Neck Surg. 2013 Oct;139(10):996-1001
23989194