Gastroesophageal reflux (GER) may induce respiratory symptoms (RS) through inhalation of acid gastric contents.
To characterize the airway inflammation associated with this condition, 20 children [7.4 (0.9) yr old] with “difficult to treat” RS and a positive 24-h oesophageal pH monitoring (pHm) were studied and bronchoalveolar lavage (BAL) performed. The control group included 10 children [7.3 (1.3) yr], non-atopics, with a respiratory clinical history similar to the cases but no reflux, as demonstrated by a negative 24-h oesophageal pHm.
On BAL samples, in addition to inflammatory indexes, the lipid-laden macrophage (LLM) index was determined as index of gastric content inhalation.
As compared to controls, GER children had higher neutrophil proportion (), higher LLM index () and higher concentrations of interleukin (IL)-8 (), myeloperoxidase (MPO) () and elastase () in BAL fluid. In GER children, but not in controls, neutrophil proportion significantly correlated with LLM index (, ), with IL-8 (, ) and MPO levels (, ) but not with elastase concentrations. These results suggest an active pathogenetic role of IL-8 in the recruitment and activation of neutrophils in the airways of children with GER, respiratory symptoms and BAL findings suggestive of gastric content aspiration.