Chest
Original ResearchPulmonary Aspiration Shown by Scintigraphy in Gastroesophageal Reflux-Related Respiratory Disease
Section snippets
Aim of the Study
Episodes of GER with aspiration of refluxed material are more likely to occur during the nocturnal period, when the esophagus and stomach are leveled and the swallowing response to reflux and airway protection mechanisms are blunted by sleep. Therefore, we wanted to verify the impact of a gastroesophageal radionuclide study followed by overnight scan on the lung fields on the identification of an underlying GER in children with unexplained or refractory respiratory symptoms. We also wanted to
Patients
Fifty-one neurologically normal children (34 boys and 17 girls) aged 1 month to 11.5 years (median, 6.5 years) who had been referred to our unit were prospectively studied during a 3-year period. They suffered from chronic or recurrent respiratory problems (chronic cough, n = 18; recurrent pneumonia, n = 14; apnea episodes, n = 8; asthma/wheezing, n = 7; posterior laryngitis, n = 4) that were hitherto unexplained and/or had not responded satisfactorily to medical treatment such as antibiotics,
Results
No anatomic abnormality was detected during the contrast study of the upper-GI tract. All 23 children subjected to upper-GI endoscopy had normal macroscopic findings, but 21 of 23 children had histologic evidence of mild (grade 1 or G1) esophageal damage, and all had an eosinophil count < 10/high-power field, so that allergic eosinophilic esophagitis could be excluded. Intraesophageal pH study results were abnormal in 13 of 51 patients (25.5%), showing a mean reflux index of 11.3% (range, 6.5
Discussion
Although GER is regarded as a possible cause of respiratory manifestations such as recurrent pneumonia, apnea, asthma, wheezing, chronic cough, and laryngitis,1, 2 its causal role in lung disease has never been clearly established.3 Indeed, one of the very few controlled pediatric studies15 to date showed that over a 1-year follow-up period, infants with regurgitation do not acquire GERD or respiratory symptoms more often than infants without regurgitation. Furthermore, the precise correlation
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Sorting out the Relationship Between Esophageal and Pulmonary Disease
2021, Gastroenterology Clinics of North AmericaCitation Excerpt :The reflux theory proposes that gastric contents traveling up to the proximal esophagus are aspirated into the airway, leading to direct injury to airway tissue and potentially triggering bronchospasm and/or inflammation, ultimately resulting in pulmonary pathology. Gastroduodenal contents, such as pepsin and bile acids, have previously been found in the airway of patients with chronic lung disorders on both cytopathologic and radiographic studies, serving as evidence to support reflux with the aspiration of digestive contents as a pathway for GERD-related lung dysfunction.15–17 The reflux pathway can further be divided into 2 main mechanisms in causing airway pathology: macroaspiration versus microaspiration.
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2018, Current Problems in Pediatric and Adolescent Health CareCitation Excerpt :Risk factors for aspiration include having a congenital or acquired disorder that affects the anatomy and/or function of the upper airway and the gastrointestinal tract, which result in swallowing dysfunction, incoordination of swallow and breathing, and/or circumstances that overcome the child’s capacity to protect their airway from aspiration.2,6,7 Conditions that are commonly associated to chronic aspiration include: genetic syndromes such as CHARGE syndrome and trisomy 21, neuromuscular or neurological disorders,1,8 congenital malformations resulting in craniofacial abnormalities such as midface hypoplasia in children with skeletal dysplasia, and gastrointestinal disorders such as achalasia, esophageal stenosis, and gastroesophageal reflux disease.8,9 Therapy with positive pressure such as non-invasive positive pressure ventilation (NIPPV; e.g., CPAP) and/or airway clearance therapy like cough assist are risk factors for aspiration of secretions or material pooled around the larynx.
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The authors have no conflicts of interest to disclose.