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GERD related micro-aspiration in chronic mustard-induced pulmonary disorder

Rasoul Aliannejad1, Seyed-Mehdi Hashemi-Bajgani, Asharaf Karbasi

  • 1Respiratory Diseases and TB Research Center of Guilan University of Medical Science, Razi Hospital, Rasht, Iran.

Journal of Research in Medical Sciences : the Official Journal of Isfahan University of Medical Sciences
|June 27, 2013
PubMed
Abstract

Insights

Sulfur mustard (SM) gas exposure can cause bronchiolitis obliterans (BO). This study found that most BO patients suffer from gastro-esophageal reflux (GER), which may worsen their chronic lung disease exacerbations.

Area of Science:

  • Pulmonary Medicine
  • Toxicology
  • Gastroenterology

Background:

  • Bronchiolitis obliterans (BO) is a significant pulmonary complication following sulfur mustard (SM) gas exposure.
  • SM gas was used against Iranian civilians and military personnel during the Iran-Iraq war, leading to long-term health issues.
  • Chronic pulmonary diseases and recurrent exacerbations are common in SM-exposed individuals.

Purpose of the Study:

  • To investigate the prevalence of gastro-esophageal reflux (GER) and gastric micro-aspiration in patients with chronic pulmonary diseases after SM gas injury.
  • To assess the potential role of GER in exacerbations of lung disease in SM survivors.

Main Methods:

  • A cross-sectional study was conducted at Baqiyatallah University of Medical Sciences, Tehran, Iran.
  • Gastric micro-aspiration and GER were evaluated by analyzing bile acids, pepsin, and trypsin in bronchoalveolar lavage (BAL) fluid.
  • BAL fluid analysis included detection of bile acids, pepsin, and trypsin.

Main Results:

  • Bile acids were detected in the BAL fluid of 75% of patients (21.4% high, 53.6% low).
  • No bile was detected in only 16% of patients.
  • Pepsin and trypsin were present in the BAL fluid of all evaluated patients.

Conclusions:

  • The majority of BO patients exposed to SM exhibit signs of GER.
  • Unlike post-lung transplant BO, the typical etiologic factors for GER are absent in these patients.
  • GER is hypothesized to be an aggravating factor for exacerbations in SM-induced BO, warranting further investigation into its pathophysiological mechanisms and treatment.
Keywords:
Bronchiolitis obliteransgastro-esophageal refluxsulfur mustard

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