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Pepsin aspiration

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https://www.readbyqxmd.com/read/29774546/pepsin-biomarker-mediator-and-therapeutic-target-for-reflux-and-aspiration
#1
REVIEW
Nikki Johnston, Peter W Dettmar, Frank G Ondrey, Rahul Nanchal, Sang-Hyuk Lee, Jonathan M Bock
Extra-esophageal reflux is suspected to cause a wide range of clinical symptoms in the upper airways. Diagnosis and treatment has focused on acid, but realization of the role of nonacid reflux has resulted in research investigating the use of pepsin as a biomarker for gastric reflux and aspiration. Pepsin analysis can complement the use of questionnaires and office-based diagnosis and lessen the dependency on invasive and expensive diagnostic tests. Furthermore, pepsin as a first-line diagnostic biomarker has been shown to improve the accuracy of reflux diagnosis...
May 17, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29768111/effect-of-right-lateral-position-with-head-elevation-on-tracheal-aspirate-pepsin-in-ventilated-preterm-neonates-randomized-controlled-trial
#2
Safaa Shafik Imam, Dina Mohamed Shinkar, Nevine Ahmed Mohamed, Hebatallah Elhamy Mansour
OBJECTIVE: To evaluate the effect of right lateral positioning in comparison with supine positioning on tracheal aspirate pepsin levels as a marker of aspiration of gastric contents in ventilated preterm neonates. STUDY DESIGN: This randomized controlled trial was conducted on 60 ventilated preterm neonates <35 weeks; 30 neonates were nursed in right lateral position for 6 hours while the other 30 neonates were nursed in supine position for 6 hours. Tracheal aspirate sample was obtained from each neonate in both the groups just after the end of 6 hours and pepsin level was measured...
May 15, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29456774/gastric-aspiration-and-its-role-in-airway-inflammation
#3
REVIEW
E B Hunt, A Sullivan, J Galvin, J MacSharry, D M Murphy
Gastro-Oesophageal Reflux (GOR) has been associated with chronic airway diseases while the passage of foreign matter into airways and lungs through aspiration has the potential to initiate a wide spectrum of pulmonary disorders. The clinical syndrome resulting from such aspiration will depend both on the quantity and nature of the aspirate as well as the individual host response. Aspiration of gastric fluids may cause damage to airway epithelium, not only because acidity is toxic to bronchial epithelial cells but also due to the effect of digestive enzymes such as pepsin and bile salts...
2018: Open Respiratory Medicine Journal
https://www.readbyqxmd.com/read/29092869/testing-placement-of-gastric-feeding-tubes-in-infants
#4
Norma A Metheny, Ann Pawluszka, Melanie Lulic, Leslie J Hinyard, Kathleen L Meert
BACKGROUND: Inadvertent positioning of a nasogastric tube in the lung can cause serious complications, so identifying methods to detect improperly inserted tubes is imperative. OBJECTIVES: To compare the sensitivity, specificity, and negative and positive predictive values of 4 pH cut points (< 4.0, < 4.5, < 5.0, and < 5.5) in differentiating gastric and tracheal aspirates under various treatment conditions and to explore the utility of a pepsin assay for distinguishing between gastric and tracheal aspirates...
November 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28960597/ideal-cricoid-pressure-is-biomechanically-impossible-during-laryngoscopy
#5
Christopher E Trethewy, Steven R Doherty, Julie M Burrows, Don Clausen
OBJECTIVE: This study was a prospective, randomized controlled trial of rapid sequence intubation (RSI) with cricoid pressure (CP) within the emergency department (ED). The primary aim of the study was to examine the link between ideal CP and the incidence of aspiration. METHOD: Patients > 18 years of age undergoing RSI in the ED of two hospitals in New South Wales, Australia, were randomly assigned to receive measured CP using weighing scales to target the ideal CP range (3...
January 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28906320/changes-in-proteases-antiproteases-and-bioactive-proteins-from-mother-s-breast-milk-to-the-premature-infant-stomach
#6
Veronique Demers-Mathieu, Søren Drud Nielsen, Mark A Underwood, Robyn Borghese, David C Dallas
OBJECTIVE: Our previous studies suggested that human milk proteases begin to hydrolyze proteins in the mammary gland and continue within the term infant' stomach. No research has measured milk protease and pepsin activity in the gastric aspirates of preterm infants after human milk feeding. This study investigated how the concentrations of human milk proteases and protease inhibitors changed in the premature infant stomach. METHODS: Human milk and infant gastric samples were collected from 18 preterm-delivering mother-infant pairs (24-32 week gestational age)...
February 2018: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28303301/impact-of-tapered-cuff-tracheal-tube-on-microaspiration-of-gastric-contents-in-intubated-critically-ill-patients-a-multicenter-cluster-randomized-cross-over-controlled-trial
#7
Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Farid Zerimech, Hélène Behal, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacori, Isabelle Alves, Stéphanie Barrailler, Julien Labreuche, Laurent Robriquet, Fabienne Tamion, Emmanuel Delaporte, Damien Thellier, Claire Delcourte, Alain Duhamel, Saad Nseir
PURPOSE: Studies on the impact of tapered-cuff tracheal tubes on rates of microaspiration and ventilator-associated pneumonia (VAP) in intubated patients have reported conflicting results. The aim of this study was to determine the influence of this shape of tracheal cuff on abundant microaspiration of gastric contents in critically ill patients. METHODS: All patients intubated in the intensive care unit (ICU) and requiring mechanical ventilation for at least 48 h were eligible for this multicenter cluster-randomized controlled cross-over open-label study...
November 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28300572/the-potential-role-of-aspiration-in-the-asthmatic-airway
#8
Eoin B Hunt, Chris Ward, Stephen Power, Ashley Sullivan, Jeffrey P Pearson, Susan Lapthorne, Paul M O'Byrne, Joseph Eustace, Barry J Plant, Michael M Maher, John MacSharry, Desmond M Murphy
BACKGROUND: Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control? METHODS: Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, and spirometry performed to characterize their level of asthma control...
June 2017: Chest
https://www.readbyqxmd.com/read/28214603/the-impact-of-reduced-gastric-acid-secretion-on-dissolution-of-salts-of-weak-bases-in-the-fasted-upper-gastrointestinal-lumen-data-in-biorelevant-media-and-in-human-aspirates
#9
Chara Litou, Maria Vertzoni, Wei Xu, Filippos Kesisoglou, Christos Reppas
PURPOSE: To propose media for simulating the intragastric environment under reduced gastric acid secretion in the fasted state at three levels of simulation of the gastric environment and evaluate their usefulness in evaluating the intragastric dissolution of salts of weak bases. To evaluate the importance of bicarbonate buffer in biorelevant in vitro dissolution testing when using Level II biorelevant media simulating the environment in the fasted upper small intestine, regardless of gastric acid secretions...
June 2017: European Journal of Pharmaceutics and Biopharmaceutics
https://www.readbyqxmd.com/read/27704488/efficiency-of-an-electronic-device-in-controlling-tracheal-cuff-pressure-in-critically-ill-patients-a-randomized-controlled-crossover-study
#10
Anahita Rouzé, Julien De Jonckheere, Farid Zerimech, Julien Labreuche, Erika Parmentier-Decrucq, Benoit Voisin, Emmanuelle Jaillette, Patrice Maboudou, Malika Balduyck, Saad Nseir
BACKGROUND: Despite intermittent control of tracheal cuff pressure (P cuff) using a manual manometer, cuff underinflation (<20 cmH2O) and overinflation (>30 cmH2O) frequently occur in intubated critically ill patients, resulting in increased risk of microaspiration and tracheal ischemic lesions. The primary objective of our study was to determine the efficiency of an electronic device in continuously controlling P cuff. The secondary objective was to determine the impact of this device on the occurrence of microaspiration of gastric or oropharyngeal secretions...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27646537/respiratory-symptoms-sleep-disordered-breathing-and-biomarkers-in-nocturnal-gastroesophageal-reflux
#11
Össur Ingi Emilsson, Bryndís Benediktsdóttir, Ísleifur Ólafsson, Elizabeth Cook, Sigurður Júlíusson, Einar Stefán Björnsson, Sunna Guðlaugsdóttir, Anna Soffía Guðmundsdóttir, Ekaterina Mirgorodskaya, Evert Ljungström, Erna Sif Arnardóttir, Þórarinn Gíslason, Christer Janson, Anna-Carin Olin
BACKGROUND: Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation. METHODS: Participants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study...
September 20, 2016: Respiratory Research
https://www.readbyqxmd.com/read/27522714/-incidence-pathomorphism-and-outcomes-of-the-bronchopulmonary-dysplasia-associated-with-microaspiration-of-gastric-contents
#12
E Y Bryksina, V S Bryksin, A V Pochivalov
UNLABELLED: Today the influence of the digestive tract functional violations followed by microaspiration of gastric contents (MAGC) on the incidence, features and outcomes of bronchopulmonary dysplasia BPD) remains little studied. Focusing on this aspect makes the research actual. OBJECTIVE: determination of the nature of influence of MAGC on the progress and course of BPD. METHODS: 373 newborns exposed to artificial pulmonary ventilation (APV) in the neonatal period were examined...
2016: Vestnik Rossiĭskoĭ Akademii Meditsinskikh Nauk
https://www.readbyqxmd.com/read/27516725/clinical-utility-of-bronchoalveolar-lavage-pepsin-in-diagnosis-of-gastroesophageal-reflux-among-wheezy-infants
#13
Ahmed Fathi Abdallah, Tarek El-Desoky, Khalid Fathi, Wagdy Fawzi Elkashef, Ahmed Zaki
Background. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing. Objectives. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants. Methods. Fifty-two wheezy infants were evaluated for GERD using esophageal combined impedance-pH (MII-pH) monitoring, esophagogastroduodenoscopy with esophageal biopsies, and BAL pepsin. Tracheobronchial aspirates from 10 healthy infants planned for surgery without history of respiratory problems were examined for pepsin...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/27273863/a-pilot-randomized-clinical-trial-assessing-the-effect-of-cricoid-pressure-on-risk-of-aspiration
#14
J Kyle Bohman, Rahul Kashyap, Augustine Lee, Zhaoping He, Sam Soundar, Laura L Bolling, Daryl J Kor
INTRODUCTION: Patients at risk for microaspiration during elective intubation often receive cricoid pressure in the hopes of mitigating such risk. However, there is scarce evidence to either support or reject this practice. The objective of this investigation was to assess the effect of cricoid pressure on microaspiration and to inform the potential feasibility of conducting a larger, more definitive clinical trial. METHODS: This was a pilot randomized clinical trial set in the operating rooms of a tertiary referral hospital between August and October of 2014...
January 2018: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/26890709/pepsinogen-identification-in-the-middle-ear-fluid-of-children-with-otitis-media-with-effusion
#15
COMPARATIVE STUDY
Aytuğ Buyruk, Üstün Osma, Mustafa Deniz Yılmaz, Hülya Eyigör
OBJECTIVES: This study aims to investigate the presence and concentration of pepsin/pepsinogen in middle ear fluid and to discuss the potential mechanisms involved in the pathogenesis of this condition. PATIENTS AND METHODS: A total of 33 children (21 boys, 12 girls; mean age 5.7±2.4 years; range 3 to 13 years) diagnosed with otitis media with effusion and scheduled for operation were enrolled into the study. Fluids aspirated from the middle ear were assessed for the presence of pepsinogen and albumin and blood samples were drawn simultaneously for comparison...
2016: Kulak Burun Boğaz Ihtisas Dergisi: KBB, Journal of Ear, Nose, and Throat
https://www.readbyqxmd.com/read/26872366/tapered-cuff-endotracheal-tube-does-not-prevent-early-postoperative-pneumonia-compared-with-spherical-cuff-endotracheal-tube-after-major-vascular-surgery-a-randomized-controlled-trial
#16
RANDOMIZED CONTROLLED TRIAL
Antoine Monsel, Qin Lu, Marine Le Corre, Hélène Brisson, Charlotte Arbelot, Corinne Vezinet, Marie-Hélène Fléron, Christina Ibanez-Estève, Farid Zerimech, Malika Balduyck, Felippe Dexheimer, Chunyao Wang, Olivier Langeron, Jean-Jacques Rouby, Liliane Bodin, Romain Deransy, Pierre Garçon, Hatem Douiri, Ismael Khalifa, Antoine Pons, Wen-Jie Gu, Fabien Koskas, Julien Gaudric
BACKGROUND: Patients undergoing major vascular surgery often develop postoperative pneumonia that impacts their outcomes. Conflicting data exist concerning the potential benefit of tapered-shaped cuffs on tracheal sealing. The primary objective of this study was to assess the efficiency of a polyvinyl chloride tapered-cuff endotracheal tube at reducing the postoperative pneumonia rate after major vascular surgery. Secondary objectives were to determine its impact on microaspiration, ventilator-associated pneumonia rate, and inner cuff pressure...
May 2016: Anesthesiology
https://www.readbyqxmd.com/read/26794490/gastroesophageal-reflux-burden-even-in-children-that-aspirate-does-not-increase-pediatric-hospitalization
#17
Daniel R Duncan, Janine Amirault, Nikki Johnston, Paul Mitchell, Kara Larson, Rachel L Rosen
OBJECTIVES: Gastroesophageal reflux is common but remains a controversial disease to diagnose and treat and little is known about the role of reflux testing in predicting clinical outcomes, particularly in children at risk for extraesophageal reflux complications. The aim of this study was to determine if rates of hospitalization were affected by reflux burden even after adjusting for aspiration risk. METHODS: We prospectively recruited, between 2009 and 2014, a cohort of pediatric patients with suspected extraesophageal reflux disease who were referred for reflux testing and underwent both multichannel intraluminal impedance with pH (pH-MII) and modified barium swallow studies...
August 2016: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/26407612/impact-of-tracheal-cuff-shape-on-microaspiration-of-gastric-contents-in-intubated-critically-ill-patients-study-protocol-for-a-randomized-controlled-trial
#18
RANDOMIZED CONTROLLED TRIAL
Emmanuelle Jaillette, Guillaume Brunin, Christophe Girault, Farid Zerimech, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacori, Isabelle Alves, Stephanie Barrailler, Laurent Robriquet, Fabienne Tamion, Emmanuel Delaporte, Damien Thellier, Claire Delcourte, Alain Duhamel, Saad Nseir
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common infection in intubated critically ill patients. Microaspiration of the contaminated gastric and oropharyngeal secretions is the main mechanism involved in the pathophysiology of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. Previous in vitro studies suggested that conical cuff shape might be helpful in improving tracheal sealing. However, clinical studies found conflicting results...
September 25, 2015: Trials
https://www.readbyqxmd.com/read/26238826/pepsin-a-silent-biomarker-for-reflux-aspiration-or-an-active-player-in-extra-esophageal-mucosal-injury
#19
EDITORIAL
Peter J Kahrilas, Leila Kia
No abstract text is available yet for this article.
August 2015: Chest
https://www.readbyqxmd.com/read/26104973/gastroesophageal-reflux-and-lung-disease
#20
EDITORIAL
Keith C Meyer
Gastroesophageal reflux (GER) can cause respiratory symptoms and may trigger, drive and/or worsen airway disorders, interstitial lung diseases and lung allograft dysfunction. Whether lifestyle changes and acid suppression alone can counter and prevent the adverse effects of GER on the respiratory tract remains unclear. Recent data suggest that antireflux surgery may be more effective in preventing lung disease progression in patients with idiopathic pulmonary fibrosis or lung transplant recipients who have evidence of allograft dysfunction associated with the presence of excessive GER...
August 2015: Expert Review of Respiratory Medicine
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