Non-acid gastro-oesophageal reflux in children with suspected pulmonary aspiration

Background & aims: In a group of children with suspected pulmonary aspiration, we aimed to describe the type and physical characteristics of gastro-oesophageal reflux (GOR) episodes, and to determine their correlation with the lipid-laden macrophage (LLM) content in bronchoalveolar lavage (BAL). Patients and methods: Twenty-one children with a diagnosis of bronchial asthma, recurrent lung consol- idations and recurrent laryngotracheitis underwent 24-h multichannel intraluminal impedance and pH (MII-pH) monitoring, fibreoptic bronchoscopy and BAL. The following parameters were evaluated: total number of reflux episodes, number of acid reflux [AR; pH < 4] and non-acid reflux [NAR] episodes [pH > 4], height of reflux episodes, LLM content and percentage of neutrophils in the BAL. Results: The number of NAR episodes and the number of those reaching the proximal oesophagus were significantly higher in patients with recurrent lung consolidations than in those with bronchial asthma and laryngotracheitis (p < 0.01 and p < 0.01). BAL studies showed a significantly higher LLM content in children with recurrent lung consolidations than in those with bronchial asthma and laryngotracheitis (p < 0.01). The LLM content correlated significantly with the total number of reflux episodes (r = 0.73; p < 0.001) and with those reaching the proximal oesophagus (r = 0.67; p < 0.001). Finally, the LLM content correlated with the number of NAR episodes (r = 0.61; p < 0.01), with those reaching the proximal oesophagus (r = 0.64; p < 0.01) and with the percentage of BAL neutrophils (r = 0.7; p < 0.01). Conclusion: NAR episodes reaching the proximal oesophagus correlate with diagnostic marker for pulmonary micro-aspiration. MII-pH monitoring increases the yield in identifying types and proxi- mal extension of reflux episodes, that discriminate between patients with and without pulmonary aspiration.