Published online March 24, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e879-e884 (doi:10.1542/10.1542/peds.2007-0723)
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ARTICLE

Lipid-Laden Macrophage Index Is Not an Indicator of Gastroesophageal Reflux-Related Respiratory Disease in Children

Rachel Rosen, MD, MPHa, Julia Fritz, BAa, Ariela Nurkoa, Dawn Simon, MDb and Samuel Nurko, MD, MPHa

a Center for Aerodigestive Disorders, Department of Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Boston, Massachusetts
b Department of Pediatric Pulmonary Medicine, Emory University School of Medicine, Atlanta, Georgia

BACKGROUND. The lipid-laden macrophage index has been used to evaluate for gastroesophageal reflux-related respiratory disease, but the relationship between reflux detected by pH probe and the lipid-laden macrophage index is uncertain despite widespread use of the lipid-laden macrophage index in clinical decision-making. It was the aim of this study to correlate reflux as detected by multichannel intraluminal impedance with the lipid-laden macrophage index.

METHODS. Patients undergoing both pH multichannel intraluminal impedance testing and bronchoscopy between January 2002 and January 2006 were identified. Baseline characteristics were compared by using parametric and nonparametric testing. Reflux profiles were correlated with the lipid-laden macrophage index by using Spearman correlations.

RESULTS. There was no significant correlation between the lipid-laden macrophage index and the number of acid or nonacid reflux events. There also was no significant correlation between the lipid-laden macrophage index and the amount of full-column reflux. There was no significant difference between the mean lipid-laden macrophage index in patients with and without esophagitis. Finally, in patients who underwent fundoplication (n = 13) for intractable respiratory disease, there was no significant difference in any of the reflux parameters between patients who did and did not experience clinical improvement after fundoplication. There was, however, a higher lipid-laden macrophage index in patients with no symptomatic improvement compared with patients with symptomatic improvement.

CONCLUSIONS. Lipid-laden macrophage index lacks the specificity necessary to detect reflux-related respiratory disease.

Key Words: gastroesophageal reflux • pH monitoring • respiratory disease • lipid laden macrophages

Abbreviations: LLMI—lipid-laden macrophage index • GER—gastroesophageal reflux • pH-MII—pH-multichannel intraluminal impedance • GERD—gastroesophageal reflux disease

Accepted Sep 7, 2007.


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