Chest
Volume 93, Issue 2, February 1988, Pages 376-378
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Clinical Investigations
Aspiration of Solid Food Particles Into Lungs of Patients with Gastroesophageal Reflux and Chronic Bronchial Disease

https://doi.org/10.1378/chest.93.2.376Get rights and content

The existence of a relationship between upper digestive tract impairment and respiratory disturbance is generally accepted. The aim of this study was to determine whether pulmonary aspiration, documented by labeled meal and lung scans, could be a contributory factor. Thirty-two patients with chronic respiratory complaints (19 men, 13 women, mean age: 57.8 yr), 29 of whom had an FEV1 below 80 percent of predicted values, and 13 healthy subjects (six men, seven women, mean age 50.9 yr) took part in a prospective study. Scintiscans showed gastroesophageal reflux (GER) in 27 patients (84 percent) and in five control subjects (38 percent). Lung contamination was ascertained in 24 patients (75 percent) and in two control subjects (15 percent) (p<0.001) 15 hours after a labeled solid meal. Vegetal fibers were found in sputum smears after mouth rinsing the day after ingestion of 8.5 g wheat bran in 72 percent of patients and in 77 percent of control subjects. Although two associated phenomena are not necessarily causally related, pulmonary aspiration documented by pulmonary scintigraphy did significantly correlate with gastroesophageal reflux, suggesting that aspiration resulting from reflux may perpetuate, if not initiate, chronic bronchial disease.

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MATERIAL AND METHODS

Thirty-two patients (19 men, 13 women) were included in the study on an outpatient basis, from October 1, 1983 to September 30, 1984. Their ages ranged from 23 to 81 yr (mean 57.8). Fourteen patients complained of chronic bronchitis, ten had a recurring cough for which no cause (including postnasal drip) was found,13 four had asthma, three were suffering from nocturnal noncardiogenic dyspnea, and one had had recurrent pulmonary infections since surgical treatment for congenital esophageal

RESULTS

Chest x-ray film findings were normal in patients and control subjects. Sixteen patients had sinus films showing evidence of past sinusitis. FEV1 below 80 percent of predicted value was observed in 29 patients (90 percent). There was no ventilatory impairment in control subjects. Vegetal fibers were found in sputum smears in 23 patients (72 percent) and in ten control subjects (77 percent). One patient and none of the control group had vegetal fibers in the rinsing liquid of the oral cavity.

DISCUSSION

Effective pulmonary defense mechanisms protect individuals from untoward consequences of aspiration into the respiratory tract of oropharyngeal secretions,16 which seems to be a frequent phenomenon in normal subjects during sleep.17 As a matter of fact, vegetal fibers were evidenced in sputum smears from control subjects (77 percent), as well as from patients (72 percent). Yet, only one patient and none of the control subjects had vegetal fibers in the rinsing liquid of the mouth obtained early

ACKNOWLEDGMENT

The authors are grateful to R. Vejdosky, MD, for cytologic examination, to Mrs. A. Bischof-Delaloye MD, for performing the scintiscans, to Prof. PE Pilet, and to JJ Gonvers, MD for advice.

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