Oliviero Sacco1, Michela Silvestri2, Michele Ghezzi3, Antonino Capizzi4, Giovanni A Rossi5. 1. Department of Pediatrics, Pulmonary and Allergy Disease Pediatric Unit and Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Electronic address: olivierosacco@gaslini.org. 2. Department of Pediatrics, Pulmonary and Allergy Disease Pediatric Unit and Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Electronic address: michelasilvestri@gaslini.org. 3. Department of Pediatrics, Pulmonary and Allergy Disease Pediatric Unit and Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Electronic address: micheleghezzi83@yahoo.it. 4. Department of Pediatrics, Pulmonary and Allergy Disease Pediatric Unit and Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Electronic address: anto.capizzi@virgilio.it. 5. Department of Pediatrics, Pulmonary and Allergy Disease Pediatric Unit and Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Electronic address: giovannirossi@gaslini.org.
Abstract
BACKGROUND: In children with gastroesophageal reflux (GER) both acid refluxes (AR) and weakly acidic refluxes (WAR) can induce respiratory symptoms (RS). METHODS: To characterize the airway inflammation in children with more prevalent WAR or AR (defined according a ROC curve analysis), we performed a 3 year-retrospective review of the medical records of patients who underwent fiberoptic bronchoscopy for difficult-to-treat chronic/recurrent respiratory symptoms and who had a positive multiple intraluminal esophageal impedance (pH/MII) monitoring. RESULTS: In the 13 WAR and 11 AR children, the number of cells recovered by bronchoalveolar lavage (BAL) was similar [0.78 (0.29-1.28) x 106 cells, and 1.05 (0.68-1.64) x 106 cells, respectively] (P = 0.22). A neutrophilic alveolitis and an elevated lipid-laden-macrophage (LLM) index were detected in both groups: no differences were found in neutrophils and lymphocyte percentages or in LLM index between WAR and AR children. In contrast, higher BAL epithelial cell proportions were seen in WAR [10.4 (4.85-23.45) %], as compared to AR [2.5 (1.25-7.25) %] children (P = 0.0045), suggesting greater airway damage in the formers. In the whole patient population a significant correlation was found between the proportions of BAL epithelial cells and the number of WAR events (r = 0.43; P = 0.037). Finally, elevated BAL concentrations of substance P and of pepsin were observed, not statistically different in the WAR and AR groups. CONCLUSIONS: In this patient population, WAR events can be associated with a significant airway inflammation and injury that, because of the biochemical mechanisms involved, are likely not completely preventable and/or counteracted by anti-acid treatments.
BACKGROUND: In children with gastroesophageal reflux (GER) both acid refluxes (AR) and weakly acidic refluxes (WAR) can induce respiratory symptoms (RS). METHODS: To characterize the airway inflammation in children with more prevalent WAR or AR (defined according a ROC curve analysis), we performed a 3 year-retrospective review of the medical records of patients who underwent fiberoptic bronchoscopy for difficult-to-treat chronic/recurrent respiratory symptoms and who had a positive multiple intraluminal esophageal impedance (pH/MII) monitoring. RESULTS: In the 13 WAR and 11 AR children, the number of cells recovered by bronchoalveolar lavage (BAL) was similar [0.78 (0.29-1.28) x 106 cells, and 1.05 (0.68-1.64) x 106 cells, respectively] (P = 0.22). A neutrophilic alveolitis and an elevated lipid-laden-macrophage (LLM) index were detected in both groups: no differences were found in neutrophils and lymphocyte percentages or in LLM index between WAR and AR children. In contrast, higher BAL epithelial cell proportions were seen in WAR [10.4 (4.85-23.45) %], as compared to AR [2.5 (1.25-7.25) %] children (P = 0.0045), suggesting greater airway damage in the formers. In the whole patient population a significant correlation was found between the proportions of BAL epithelial cells and the number of WAR events (r = 0.43; P = 0.037). Finally, elevated BAL concentrations of substance P and of pepsin were observed, not statistically different in the WAR and AR groups. CONCLUSIONS: In this patient population, WAR events can be associated with a significant airway inflammation and injury that, because of the biochemical mechanisms involved, are likely not completely preventable and/or counteracted by anti-acid treatments.
Authors: Sudarshan R Jadcherla; Zakia Sultana; Kathryn A Hasenstab-Kenney; Varsha Prabhakar; Ish K Gulati; Carlo Di Lorenzo Journal: Pediatr Res Date: 2020-05-06 Impact factor: 3.756