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Reflux aspiration in children with neurodisability--a significant problem, but can we measure it?
Ruth Trinick1, Nikki Johnston, A Mark Dalzell
1Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Insights
Identifying biomarkers for reflux aspiration in children with neurodisability is crucial. This review examines existing and novel methods in bronchoalveolar lavage fluid to aid surgical assessment and clinical trials.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Biomarker Discovery
Background:
- Recurrent respiratory problems and deterioration are leading causes of mortality in children with severe neurodisability.
- Pulmonary aspiration, including direct food/saliva and gastric reflux aspiration, is a significant contributing factor.
- Distinguishing between direct and reflux aspiration is challenging, complicating patient management and surgical candidacy assessment.
Purpose of the Study:
- To review existing and novel biomarkers for aspiration in bronchoalveolar lavage fluid.
- To evaluate the utility of these biomarkers in surgical assessment and clinical trials for antireflux surgery.
- To understand the impact of aspirated substances on lung pathology.
Main Methods:
- Review of existing literature on aspiration biomarkers in bronchoalveolar lavage fluid.
- Discussion of the limitations of the lipid-laden macrophage index.
- Exploration of laboratory methods for novel biomarkers like pepsin and bile acids.
Main Results:
- The lipid-laden macrophage index has limitations in specificity and reliability.
- Pepsin and bile acids show promise as novel biomarkers for reflux aspiration.
- Further research is needed to understand the in vivo and in vitro effects of aspirated substances on the lung.
Conclusions:
- Accurate biomarkers are needed to differentiate aspiration types in neurodisability.
- Novel biomarkers like pepsin and bile acids may improve surgical assessment and outcome measurement.
- Investigating the lung's response to aspirated materials is essential for clinical understanding.
Abstract:
Recurrent respiratory problems are common in children with severe neurodisability, and respiratory deterioration is a leading cause of premature death in this group. Although the etiology is multifactorial, recurrent pulmonary aspiration is thought to play a significant role. Gastroesophageal reflux is known to be common, as is oral-motor discoordination. Differentiating direct aspiration of food and saliva and gastric reflux aspiration is difficult and presents a challenge in managing patients and assessing their suitability for surgical antireflux procedures. This is particularly the case when children present with predominantly respiratory symptoms, where there may be direct aspiration, reflux aspiration, neither, or both. A clinical biomarker to identify and quantify reflux aspiration would therefore be useful in surgical assessment and may also be applicable as an outcome measure for clinical trials of antireflux surgery. In this review, we discuss the evidence base behind existing and potentially novel biomarkers of aspiration in bronchoalveolar lavage fluid. We highlight the limitations of the lipid-laden macrophage index, particularly with regard to its specificity and interrater/intrarater reliability. We discuss the laboratory methods available to measure promising new biomarkers (pepsin and bile acids) and highlight their potential advantages and disadvantages. Finally, to understand how aspiration causes clinical signs and symptoms in our patients, we need to study the effect of aspirated substances on the lung, and here we review the available in vivo and in vitro literature.
