Abstract
Research Motivation: Gastroesophageal reflux disease (GERD) is a well-recognised cause of respiratory symptoms in children. Confirming a diagnosis of reflux aspiration remains difficult, due to limitations in currently available investigations. The presence of pepsin in respiratory secretions has been documented in literature as a marker of reflux aspiration; however the correlation of pepsin assay results with clinical outcomes has not previously been reported. Aim : This study investigates the way in which results of pepsin assays influence the management of children with suspected reflux aspiration, as well as clinician attitudes towards pepsin assay. Methodology: Retrospective chart review of 318 patient records from January 2005 – December 2009, at Sydney Children’s Hospital. Pepsin assay results were compared with results from other standard investigations for GERD. Findings: Children with GERD and respiratory symptoms were 1.8 times as likely to be positive for pepsin compared to children without respiratory symptoms (OR 1.8, 95% C.I. = 1.09 -2.96). A significantly greater quantity of pepsin was detected in tracheal aspirates of children with GERD and respiratory symptoms compared to those without (median 43, 0-996FU, p=0.002). In children with GERD and respiratory symptoms, pepsin assay, unlike standard GERD investigations was the only tool found to have statistical significance as a marker of possible reflux aspiration. Clinicians found the pepsin assay to be useful in the management of children with suspected reflux aspiration. Implications: The findings of this study show that the pepsin assay helps in the assessment of children with GERD and respiratory symptoms in who reflux aspiration are suspected.
Highlights
Gastroesophageal reflux disease (GERD) is a well-recognised cause of respiratory symptoms in children and is known to exacerbate pre-existing respiratory disease[1]
Implications: The findings of this study show that the pepsin assay helps in the assessment of children with GERD and respiratory symptoms in who reflux aspiration are suspected
Aspiration related to gastroesophageal reflux disease (GERD) is known to cause both upper and lower respiratory tract symptoms in children
Summary
Gastroesophageal reflux disease (GERD) is a well-recognised cause of respiratory symptoms in children and is known to exacerbate pre-existing respiratory disease[1]. The author 3 was one of the first to report that the use of pepsin assay in conjunction with standard investigations helps to more accurately diagnose reflux aspiration, in comparison to the use of standard investigations for GERD alone. In this study of children with reflux symptoms and respiratory disease, the authors found 84% of patients with respiratory disease and reflux symptom were pepsin positive. 87% of children with respiratory disease but no reflux symptoms were pepsin negative. Several papers have commented on the role of pepsin as a marker of reflux aspiration including the recent joint ESPGHAN and NASPGHAN guidelines on the management of GERD in children[20, 21, 22, 23, 24, 25,26]. This study investigates the way in which pepsin assays influence patient management and clinician attitudes towards pepsin assay within paediatric medicine
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