ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of
chronic, progressive fibrosing interstitial pneumonia of unknown cause.Recently,
there is increasing evidence supporting a relationship between gastroesophageal
reflux, microaspiration, and IPF, since the diagnostic gold-standard for
microaspiration remains unknown. So, the aim of this study is to assess the
presence of chronic microaspirates by bronchoalveolar lavage pepsin level in these
patients.
Patients and method: A case -control study was conducted at Chest Department
and outpatient clinics Faculty of Medicine, Zagazig University hospitals in the
period from (February 2013 till January 2016) on thirty patients with stable
interstitial lung diseases (ILD).they were divided into two groups: 15 patients
(group I) with stable idiopathic pulmonary fibrosis (IPF), another 15 patients
(group II) stable ILD other than IPF. Both groups underwent pulmonary function
tests (PFTs), Pulmonary HRCT and Bronchoscopy. Measurement of
bronchoalveolar lavage pepsin level was done for all patients. Results: 80% of IPF
patients complained from gastroesophageal reflux with a statistically significant
decrease in PaO2, FEV1 and FVC than in non IPF patients.Bronchoalveolar lavage
pepsin level was (43.711.4ng/ml) in IPF group, which was significantly higher
than non IPF group (32.710.5 ng/ml).Also total cell count in IPF patients were
increased significantly including neutrophils, alveolar macrophages and red blood.
Increased reticulation on HRCT for IPF patients group were associated with higher
BAL pepsin levels (p <0.01). Regression coefficient revealed the most powerful
predictor of IPF severity were; HRCT findings: reticulation score,honeycombing
score[(Odds ratio(95%CI)=5.3 (1.9 to14.9), 7.8 (2.7 to 22.3)respectively],pepsin
level[(Odds ratio(95%CI)=4.6 (1.9–11.4)],FEV1 and FVC[(Odds ratio(95%CI)=3.7
(1.6 to 8.9), 3.2 (1.4 to 7.5)respectively].while gastroesophageal reflux symptom
[(Odds ratio(95%CI)=1.04(0.94-1.14)] was the least powerful predictor.
Conclusion: Gastroesophageal reflux or microaspiration is common in patients
with IPF, associated with elevated levels of pepsin in BAL fluid.
KEYWORDS: Idiopathic pulmonary fibrosis; bronchoalveolar lavage pepsin level;
gastroesophageal reflux.