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Lipid-Laden Alveolar Macrophages and pH Monitoring in Gastroesophageal Reflux-Related Respiratory Symptoms

R Kitz1, H J Boehles, M Rosewich

  • 1Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.

Pulmonary Medicine
|March 27, 2012
PubMed

Insights

Detecting lipid-laden macrophages in bronchoalveolar lavage fluid does not reliably diagnose chronic aspiration in children with gastroesophageal reflux (GER). Further research is needed for more specific diagnostic markers.

Area of Science:

  • Pediatric Pulmonology
  • Gastroenterology
  • Diagnostic Medicine

Background:

  • Gastroesophageal reflux (GER) is linked to respiratory issues in children.
  • Lipid-laden alveolar macrophages and pH monitoring are diagnostic tools for chronic aspiration in GER.
  • Proximal GER is hypothesized to correlate better with aspiration than distal GER.

Purpose of the Study:

  • To investigate the correlation between alimentary pulmonary fat phagocytosis and proximal gastroesophageal reflux.
  • To determine if lipid-laden macrophages in bronchoalveolar lavage (BAL) can confirm chronic aspiration in pediatric GER patients.

Main Methods:

  • 24-hour double-channel pH monitoring and bronchoscopy with BAL were performed on children (6 months-16 years) with unexplained respiratory symptoms.
  • Aspiration was assessed by quantifying lipid-laden alveolar macrophages in BAL specimens.
  • Correlation analysis was conducted between pH monitoring parameters and macrophage counts.

Main Results:

  • No significant correlation was found between any pH monitoring parameters and lipid-laden macrophage counts in the study population.
  • This lack of correlation persisted even when analyzing subgroups with clinically significant GER.
  • Lipid-laden macrophages in BAL lacked sufficient specificity to confirm chronic aspiration in GER-related respiratory disorders.

Conclusions:

  • Quantifying lipid-laden alveolar macrophages in BAL is not a specific diagnostic marker for chronic aspiration in children with GER-related respiratory issues.
  • Current diagnostic methods may not adequately identify aspiration as an etiology in these patients.
  • There is a need to explore alternative biomarkers for diagnosing pulmonary aspiration in pediatric GER.

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