Study finds, Positive Bronchoalveolar Lavage Pepsin Assay As
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A Study was conducted to assess the association between commonly obtained endoscopic and serologic data and bronchoalveolar lavage pepsin assay (BAL) results in children with chronic cough.

A retrospective chart review of 72 children with a BAL pepsin over an 18 month period was performed. BAL outcomes include evidence of viral, bacterial, or fungal infection, presence of lipid laden macrophages, and cytology (eosinophils, neutrophils, and lymphocytes). Gastrointestinal outcomes include esophagogastroduodenoscopy (EGD) and pH impedance probe findings. Other characteristics include serum eosinophil, neutrophils, and lymphocytes; spirometry; FeNO; and IgE.

--72 patients underwent BAL pepsin testing. Median age was 4.9 years, 30.6% had severe persistent asthma, and 59.2% were on reflux medication.

--There was an association between positive BAL pepsin assay and positive viral panel or fungal culture.

--No significant association found between positive BAL bacterial culture; BAL cytology; presence of BAL lipid laden macrophages; IgE; spirometry; FeNO; CBC neutrophil, eosinophil, or lymphocytes; pH impedance testing parameters; or EGD pathology.

BAL pepsin is linked to a positive BAL viral PCR or fungal culture, conclusively. Microaspiration may be caused by an acute occurrence (such as a respiratory infection) rather than chronic GERD, based on the lack of association between pepsinpositivity and pHimpedance parameters or EGD pathology. When a BAL pepsin is obtained in the presence of a positive viral panel or fungal culture, this could be particularly true.