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Gastrointestinal factors associated with risk of bronchiectasis in children
Daniel R Duncan1, Alexandra Cohen1, Clare Golden1
1Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Enteral tubes significantly increase bronchiectasis risk in children, while gastroesophageal reflux does not. Elevated bronchoalveolar lavage neutrophils may indicate bronchiectasis, warranting chest CT evaluation.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Medical Imaging
Background:
- Bronchiectasis in children presents diagnostic challenges.
- Gastrointestinal (GI) factors are increasingly recognized as potential contributors.
- Understanding these risk factors can improve early detection and management.
Purpose of the Study:
- To investigate gastrointestinal risk factors for pediatric bronchiectasis.
- To determine if upper GI tract dysmotility is associated with bronchiectasis.
- To identify predictors of bronchiectasis in children with persistent pulmonary symptoms.
Main Methods:
- Retrospective cohort study of 192 children evaluated for pulmonary symptoms.
- Comparison of baseline characteristics, comorbidities, and GI parameters between patients with and without bronchiectasis.
- Statistical analysis including Fisher's exact test, logistic regression, and ROC analyses.
Main Results:
- 24% of subjects had bronchiectasis on chest CT.
- Enteral tubes (OR 5.77) and elevated BAL neutrophils (OR 5.79) were significant risk factors.
- Neurologic comorbidities showed a decreased risk (OR 0.24); gastroesophageal reflux was not significant.
Conclusions:
- Enteral tube use is a significant risk factor for pediatric bronchiectasis.
- Elevated bronchoalveolar lavage neutrophils may warrant further investigation for bronchiectasis.
- Chest CT is recommended for children with unexplained elevated BAL neutrophils.
Objective:
To evaluate gastrointestinal (GI) risk factors for bronchiectasis in children. We hypothesized that upper GI tract dysmotility would be associated with increased risk of bronchiectasis.
Study Design:
Subjects in this retrospective cohort study included those evaluated for persistent pulmonary symptoms in the Aerodigestive Center at Boston Children's Hospital who underwent chest computed tomography (CT) between 2002 and 2019. To determine gastrointestinal predictors of bronchiectasis, baseline characteristics, comorbidities, enteral tube status, medications received, gastroesophageal reflux burden, adequacy of swallow function, esophageal dysmotility, gastric dysmotility, and neutrophil count on bronchoalveolar lavage (BAL) were compared between patients with and without bronchiectasis. Proportions were compared with Fisher's exact test and binary logistic regression with stepwise selection was used for multivariate analysis. ROC analyses were utilized to compare BAL neutrophils and bronchiectasis.
Results:
Of 192 subjects, 24% were found to have evidence of bronchiectasis on chest CT at age 7.9 ± 0.5 years. Enteral tubes (OR 5.77, 95% CI 2.25-14.83, p < 0.001) and increased BAL neutrophil count (OR 5.79, 95% CI 1.87-17.94, p = 0.002) were associated with increased risk while neurologic comorbidities were associated with decreased risk (OR 0.24, 95% CI 0.09-0.66, p = 0.006). Gastroesophageal reflux was not found to be a significant risk factor. Neutrophil counts >10% had 72% sensitivity and 60% specificity for identifying bronchiectasis.
Conclusions:
Enteral tubes were associated with significantly increased risk of bronchiectasis but gastroesophageal reflux was not. Providers should consider obtaining chest CT to evaluate for bronchiectasis in children found to have unexplained elevated BAL neutrophil count.
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