Bronchoalveolar lavage and esophageal pH monitoring data in children with "difficult to treat" respiratory symptoms

Gastroesophageal reflux (GER) may be associated with chronic or recurrent a sthmalike symptoms secondary to bronchoconstrictor reflexes and/or inhalati on of gastric content. The presence of lipid-laden alveolar macrophages has been proposed as an index to establish the degree of gastric aspiration. W e evaluated 20 children with "difficult to treat" respiratory symptoms and a clinical history suggestive of GER. All children underwent 24-hr esophage al pH monitoring (pHm) and fiberoptic bronchoscopy with bronchoalveolar lav age (BAL). The amount of lipid per single macrophage was determined by a se miquantitative method, using fluorescence microscopy to detect Nile-Red-sta ined BAL cells and calculating a lipid-laden macrophage index (LLMI). Eleven children had positive pHm recordings, suggesting the presence of GER (pH-positive patients), and 9 had negative pHm records (pH-negative patien ts). The pH-positive patients had higher percentages of neutrophils and hig her LLMI than the pH-negative children (P < 0.05). There were no correlatio ns between the pHm records and either % BAL neutrophils or LLMI in pH-posit ive or pH-negative patients (P > 0.05; each correlation). In contrast, a si ngle correlation was found between % BAL neuytrophils and LLMI, both in the pH-positive and in the pH negative patients (r = 0.72, P = 0.02 and r = 0. 71, P = 0.04, respectively). These data demonstrate that a significant proportion of pH-positive patient s with respiratory symptoms have BAL abnormalities that suggest airway infl ammation and gastric content aspiration. However, the intensity of GER as i ndicated by pH monitoring does not correspond with BAL data in all patients . Pediatr Pulmonol. 2000; 30:313-319, (C) 2000 Wiley-Liss, Inc.