ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS
Said, A., Alsowey, A., Ibraheem, H. (2017). ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS. EKB Journal Management System, 23(3), 1-9. doi: 10.21608/zumj.2017.4691
Ahmed Said; Ahmed Alsowey; Hoda Ibraheem. "ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS". EKB Journal Management System, 23, 3, 2017, 1-9. doi: 10.21608/zumj.2017.4691
Said, A., Alsowey, A., Ibraheem, H. (2017). 'ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS', EKB Journal Management System, 23(3), pp. 1-9. doi: 10.21608/zumj.2017.4691
Said, A., Alsowey, A., Ibraheem, H. ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS. EKB Journal Management System, 2017; 23(3): 1-9. doi: 10.21608/zumj.2017.4691

ASSESSMENT OF BRONCHOALVEOLAR LAVAGE PEPSIN LEVEL IN IDIOPATHIC PULMONARY FIBROSIS

Zagazig University Medical Journal
Article 2, Volume 23, Issue 3, May 2017, Page 1-9  XML PDF (908.45 K)
DOI: 10.21608/zumj.2017.4691
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Authors
Ahmed Said1; Ahmed Alsowey2; Hoda Ibraheem3
1Chest depatment, Zagazig University, Egypt
2Radiodiagnosis department, , Zagazig University, Egypt
3Clinical pathology department, , Zagazig University, Egypt
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
diopathic pulmonary fibrosis; bronchoalveolar lavage pepsin level; Gastroesophageal Reflux
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