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首页> 外文期刊>Surgical Endoscopy >The diagnostic value of gastroesophageal reflux disease (GERD) symptoms and detection of pepsin and bile acids in bronchoalveolar lavage fluid and exhaled breath condensate for identifying lung transplantation patients with GERD-induced aspiration
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The diagnostic value of gastroesophageal reflux disease (GERD) symptoms and detection of pepsin and bile acids in bronchoalveolar lavage fluid and exhaled breath condensate for identifying lung transplantation patients with GERD-induced aspiration

机译：胃食管反流病（GERD）症状的诊断价值以及检测支气管肺泡灌洗液和呼出气冷凝物中胃蛋白酶和胆汁酸对鉴别GERD引起的肺移植患者的诊断价值

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Background: Gastroesophageal reflux disease (GERD) is thought to lead to aspiration and bronchiolitis obliterans syndrome after lung transplantation. Unfortunately, the identification of patients with GERD who aspirate still lacks clear diagnostic indicators. The authors hypothesized that symptoms of GERD and detection of pepsin and bile acids in the bronchoalveolar lavage fluid (BAL) and exhaled breath condensate (EBC) are effective for identifying lung transplantation patients with GERD-induced aspiration. Methods: From November 2009 to November 2010, 85 lung transplantation patients undergoing surveillance bronchoscopy were prospectively enrolled. For these patients, self-reported symptoms of GERD were correlated with levels of pepsin and bile acids in BAL and EBC and with GERD status assessed by 24-h pH monitoring. The sensitivity and specificity of pepsin and bile acids in BAL and EBC also were compared with the presence of GERD in 24-h pH monitoring. Results: The typical symptoms of GERD (heartburn and regurgitation) had modest sensitivity and specificity for detecting GERD and aspiration. The atypical symptoms of GERD (aspiration and bronchitis) showed better identification of aspiration as measured by detection of pepsin and bile acids in BAL. The sensitivity and specificity of pepsin in BAL compared with GERD by 24-h pH monitoring were respectively 60 and 45 %, whereas the sensitivity and specificity of bile acids in BAL were 67 and 80 %. Conclusions: These data indicate that the measurement of pepsin and bile acids in BAL can provide additional data for identifying lung transplantation patients at risk for GERD-induced aspiration compared with symptoms or 24-h pH monitoring alone. These results support a diagnostic role for detecting markers of aspiration in BAL, but this must be validated in larger studies.
机译：背景：胃食管反流病（GERD）被认为会导致肺移植后出现误吸和闭塞性细支气管炎综合征。不幸的是，对吸出的GERD患者的识别仍然缺乏明确的诊断指标。作者假设，GERD的症状以及支气管肺泡灌洗液（BAL）和呼出气冷凝液（EBC）中胃蛋白酶和胆汁酸的检测可有效识别GERD诱发的肺移植患者。方法：2009年11月至2010年11月，前瞻性纳入85例行支气管镜检查的肺移植患者。对于这些患者，自我报告的GERD症状与BAL和EBC中的胃蛋白酶和胆汁酸水平以及通过24小时pH监测评估的GERD状态相关。在24小时pH监测中，还将胃蛋白酶和胆汁酸在BAL和EBC中的敏感性和特异性与GERD的存在进行了比较。结果：GERD的典型症状（胃灼热和反流）对GERD和误吸的敏感性和特异性中等。通过检测BAL中的胃蛋白酶和胆汁酸，GERD的非典型症状（误吸和支气管炎）表现出更好的误吸识别。通过24小时pH监测，胃蛋白酶在BAL中的敏感性和特异性分别为GERD和GERD的60％和45％，而胆汁酸在BAL中的敏感性和特异性分别为67％和80％。结论：这些数据表明，与单独症状或仅进行24小时pH监测相比，BAL中胃蛋白酶和胆汁酸的测定可提供更多数据，以鉴定有GERD诱发吸入风险的肺移植患者。这些结果支持了在BAL中检测抽吸标志物的诊断作用，但这必须在更大的研究中得到验证。

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