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Pepsin like activity in bronchoalveolar lavage fluid is suggestive of gastric aspiration in lung allografts

Lookup NU author(s): Professor Christopher Ward, Dr Ian Forrest, Dr Iain Brownlee, Professor Jeffrey Pearson, Professor John Dark, Emeritus Professor Paul Corris

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Abstract

Background: A biologically plausible link between gastro-oesophageal reflux (GOR), aspiration, and lung allograft dysfunction has been suggested, but there is no systematic evidence indicating the presence of gastric contents in tfie lung. We have tested the hypothesis that pepsin, as a marker of aspiration, is detectable in bronchoalveolar lavage (BAL) fluid of allograft recipients who had not reported symptoms of GOR. Methods: Standardised 3×60 ml surveillance BAL fluid samples from 13 chronologically sequential stable lung allograft recipients without chronic rejection (10 patients treated with a prophylactic proton pump inhibitor) were studied. Lavage supernatants were assayed by an ELISA based on a monospecific goat antibody for pepsin/pepsinogen. Pepsin levels were compared with those from four normal volunteer controls. Results: Pepsin levels were measurable in all allograft recipients, in keeping with gastric aspiration (median 109 ng/ml (range 35-1375)). In the control group the pepsin levels were below the limit of detection. Treatment with a proton pump inhibitor was not correlated with pepsin levels. There was no correlation between BAL fluid neutrophils and pepsin levels. Conclusion: These data demonstrate lung epithelial lining fluid concentrations of pepsin in lung allograft recipients which are much higher than blood reference levels, with no detectable pepsin in controls. This provides direct evidence of gastric aspiration, which is potentially injurious to the allograft.


Publication metadata

Author(s): Ward C, Forrest IA, Brownlee IA, Johnson GE, Murphy DM, Pearson JP, Dark JH, Corris PA

Publication type: Article

Publication status: Published

Journal: Thorax

Year: 2005

Volume: 60

Issue: 10

Pages: 872-874

Print publication date: 01/10/2005

ISSN (print): 0040-6376

ISSN (electronic): 1468-3296

Publisher: BMJ

URL: http://dx.doi.org/10.1136/thx.2004.036426

DOI: 10.1136/thx.2004.036426

PubMed id: 16055614


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