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[Severe interstitial lung disease from pathologic gastroesophageal reflux in children]
P Ahrens1, B Weimer, D Hofmann
1Abt. allg. Pädiatrie II, Johann Wolfgang Goethe-Universität, Frankfurt/Main.
Insights
Gastroesophageal reflux can cause severe interstitial lung disease, even without typical reflux symptoms. Surgical intervention resolved the condition in an 11-year-old girl, normalizing lung function.
Area of Science:
- Pulmonology
- Gastroenterology
- Pediatrics
Background:
- Interstitial lung diseases (ILDs) are a diverse group of lung conditions often leading to poor prognoses.
- Severe ILD can manifest with growth failure, pulmonary hypertension, and fibrosis.
Observation:
- An 11-year-old girl developed severe interstitial pulmonary disease at age 8, following childhood asthma.
- Diagnosis involved lung biopsy, bronchoalveolar lavage showing lipid-laden macrophages, and esophageal studies.
- The condition was linked to pathological gastroesophageal reflux, presenting as "silent aspiration" without typical GERD symptoms.
Findings:
- Standard medical therapies including steroids were ineffective.
- Omeprazole showed initial benefit, leading to surgical intervention (hemifundoplication).
- Post-surgery, the patient achieved normal lung function without medication.
Implications:
- Pathological gastroesophageal reflux should be considered in pediatric interstitial lung disease, especially with "silent aspiration".
- Early diagnosis and appropriate intervention, including surgical management, can lead to complete recovery.
- This case highlights the importance of investigating reflux in pediatric lung disease, even in the absence of overt gastrointestinal symptoms.
Abstract:
Interstitial lung diseases comprise a heterogeneous group of pulmonary conditions that cause restrictive lung disease of poor prognosis, especially if growth failure, pulmonary hypertension and fibrosis appears. We report on the case of a girl of 11 years of age who suffered from severe nonallergic asthma in early childhood and who developed severe interstitial pulmonary disease caused by gastro-oesophageal reflux at the age of 8 years. This diagnosis was established by lung biopsy, bronchoalveolar lavage and a high amount of lipid-laden alveolar macrophages, 2-level pH measurement and oesophageal biopsy. Because therapy with oral and inhaled steroids failed and Omeprazol showed benificial effects, hemifundoplication according to THAL was performed. At present the lung function is clearly normal and there is no need of any medicaments. Following the history, we can assume the pathological gastro-oesophageal reflux to be the cause of the disease. It is important to state that there were no typical symptoms at any time pointing to gastro-oesophageal reflux disease. The development of pulmonary disease by pathological reflux is very often caused by "silent aspiration". Very typically there are no symptoms such as vomiting, heartburn and pain but only signs of chronic lung disease.