Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children

• Type of Material: Article
• Authors: Rachel Rosen, Children's Hospital Boston; Julia Fritz, Children's Hospital Boston; Ariela Nurko, Children's Hospital Boston; Dawn Simon, Emory University; Samuel Nurko, Children's Hospital Boston
• Language: English
• Date: 2008-04-01
• Publisher: American Academy of Pediatrics
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2008 by the American Academy of Pediatrics.
• Final Published Version (URL): http://dx.doi.org/10.1542/peds.2007-0723
• Title of Journal or Parent Work: Pediatrics
• Volume: 121
• Issue: 4
• Start Page: E879
• End Page: E884
• Grant/Funding Information: This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases grant 1K23DK 073713-01A1.
• Keywords: PLACEBO-CONTROLLED CROSSOVER; Life Sciences & Biomedicine; DOUBLE-BLIND; gastroesophageal reflux; ASTHMA; Pediatrics; SYMPTOMS; lipid laden macrophages; OMEPRAZOLE; ALVEOLAR MACROPHAGES; pH monitoring; respiratory disease; IMPEDANCE; BRONCHOALVEOLAR LAVAGE; Science & Technology; ASPIRATION; ANTIREFLUX THERAPY
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND. The lipid-laden macrophage index has been used to evaluate for gastroesophageal reflux-related respiratory disease, but the relationship between reflux detected by pH probe and the lipid-laden macrophage index is uncertain despite widespread use of the lipid-laden macrophage index in clinical decision-making. It was the aim of this study to correlate reflux as detected by multichannel intraluminal impedance with the lipid-laden macrophage index. METHODS. Patients undergoing both pH multichannel intraluminal impedance testing and bronchoscopy between January 2002 and January 2006 were identified. Baseline characteristics were compared by using parametric and nonparametric testing. Reflux profiles were correlated with the lipid-laden macrophage index by using Spearman correlations. RESULTS. There was no significant correlation between the lipid-laden macrophage index and the number of acid or nonacid reflux events. There also was no significant correlation between the lipid-laden macrophage index and the amount of full- column reflux. There was no significant difference between the mean lipid-laden macrophage index in patients with and without esophagitis. Finally, in patients who underwent fundoplication (n = 13) for intractable respiratory disease, there was no significant difference in any of the reflux parameters between patients who did and did not experience clinical improvement after fundoplication. There was, however, a higher lipid-laden macrophage index in patients with no symptomatic improvement compared with patients with symptomatic improvement. CONCLUSIONS. Lipid-laden macrophage index lacks the specificity necessary to detect reflux-related respiratory disease.