Abstract

Objective: Bronchiolitis obliterans (BO) is a rare chronic lung disease characterized by an obstructive and inflammatory reaction that occurs after severe damage to the lower respiratory tract. The presence of wheezing, cough, rales, and mosaic perfusion, vascular attenuation, central bronchiectasis findings in high resolution computed tomography which last six weeks after pneumonia, are considered. Recurrent aspiration in patients with gastroesophageal reflux (GER) can lead to chemical and infectious damage in the lungs. We aimed to investigate the presence of GER and effect of GER on the prognosis of patients who were followed up for recurrent wheezing and diagnosed with bronchiolitis obliterans with the clinical and radiological findings.

Material and Methods: Among the persistent wheezy patients, 84 patients who had a BO diagnosis created the study group; and a control group was selected by choosing 25 GER (+) and 25 GER (-) patients of the same age and gender. Clinical and radiological improvement was evaluated after 6 months follow-up.

Results: The average diagnosis age of the patients was 2.9 years and the mean age at first wheezy attack was 9.6 months. In BO patients, the GER frequency was 41% and 63% were male. Sixty-eight of 84 patients had a follow-up HRCT and in 37 (54%) patients there was clinical and radiological improvement, in 16 (23%) patients only clinical improvement and in 5 patients (7%) only radiological improvement. Clinical and radiological improvement was not detected in the remaining 10 patients. The presence of reflux did not make a statistically significant difference on the clinical and radiological prognosis (p=0.428).

Conclusion: In conclusion, the presence of GER in the etiology, or the possibility of secondary GER in chronic obstructive pulmonary disease should be investigated in patients with BO. In our study, 41% of the patients were found to have GER. However, it was observed that the presence of GER had no effect on the clinical and radiological prognosis of the disease. We believe there is a need for controlled studies investigating GER with more sensitive methods and with a higher number of these patients.

Keywords: Bronşiyolitis obliterans, Gastroösefageal reflü

References

  1. Kurland G, Michelson P. Bronchiolitis obliterans in children. Pediatr Pulmonol 2005;39:193-208.
  2. Kim CK, Kim SW, Kim JS, Koh YY, Cohen AH, Deterding RR, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest 2001;120:1101-6.
  3. Cinel G, Doğru Ersöz D. Alt solunum yolu enfeksiyonu sonrası görülen sekeller: Bronşiyolitis obliterans. Katkı Pediatri Dergisi 2010;32:243-50.
  4. Kızılkan NU. Gastroösefageal reflü hastalığı. İçinde: Yurdakök Pediatri. 1. baskı. Ankara: Güneş Tıp Kitapevi, 2017:3507-12.
  5. Santos RV, Rosário NA, Ried CA. Postinfectious bronchiolitis obliterans: Clinical aspects and complementary tests of 48 children. J Bras Pneumol 2004;30:20-5.
  6. Li YN, Liu L, Qiao HM, Cheng H, Cheng HJ. Post-infectious bronchiolitis obliterans in children: A review of 42 cases. BMC Pediatr 2014;14:238.
  7. Colom AJ, Teper AM, Volmer WM, Diette GB. Risk factors fort the development of bronchiolitis obliterans in children. Thorax 2006;61:503-6.
  8. Aguerre V, Castaños C, Pena HG, Grenoville M, Murtagh P. Postinfectious bronchiolitis obliterans in children: Clinical and pulmonary function findings. Pediatr Pulmonol 2010;45:1180-5.
  9. Hardy KA, Schidlow DV, Zaeri N. Obliterative bronchiolitis in children. Chest 1988;93:460-6.
  10. Yalçin E, Doğru D, Haliloğlu M, Ozçelik U, Kiper N, Göçmen A. Postinfectious bronchiolitis obliterans in children: Clinical and radiological profile and prognostic factors. Respiration 2003;70:371-5.
  11. Smith KJ, Dishop MK, Fan LL, Moonnumakal SP, Smith EO, Bayindir P, et al. Diagnosis of bronchiolitis obliterans with computed tomography in children. Pediatr Allergy Immunol Pulmonol 2010;23:253-9.
  12. Zang L, IrionK, Porto NS, Abreu Silva FA. High resolution computed tomograph findings in pediatric patients with postinfectious bronchiolitis obliterans. J Thorac Imaging 1999;14:85-9.
  13. Aguerre V, Castanos C, Pena HG, Grenoville M, Murtagh P. Postinfectious bronchiolitis obliterans in children: Clinical and pulmonary function findings. Pediatr Pulmonol 2010;45:1180-5.
  14. Lino CA, Batista AK, Soares MA, de Freitas AE, Gomes LC, M Filho JH, et al. Bronchiolitis obliterans: Clinical and radiological profile of children followed-up in a reference outpatient clinic. Rev Paul Pediatr 2013;31:10-6.
  15. Sadoun D, Valeyre D, Cargill J, Volter F, Amouroux J, Battesti JP. Bronchiolitis obliterans with cryptogenetic-like organizing pneumonia. Demonstration of gastro-esophageal reflux in 5 cases. Presse Med 1988;17:2383-5.
  16. Hadjiliadis D, Duane Davis R, Steele MP, Messier RH, Lau CL, Eubanks SS, et al. Gastroesophageal reflux disease in lung transplant recipients. Clin Transplant 2003;17:363–8.
  17. Hathorn KE, Chan WW, Lo WK. Role of gastroesophageal reflux disease in lung transplantation. World J Transplant 2017;7:103-16.
  18. Liu JR, Xu XF, Zhou CJ, Yang HM, Zhao SY. Bronchiolitis obliterans organizing pneumonia due to gastroesophageal reflux. Pediatrics 2015;135:1510-3.
  19. Mauad T, Dolhnikoff M; São Paulo Bronchiolitis Obliterans Study Group. Histology of childhood bronchiolitis obliterans. Pediatr Pulmonol 2002;33:466-74.

Copyright and license

Copyright © 2019 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Siyah Bilgin B. Bronchiolitis Obliterans and Bronchiolitis Obliterans Association with Gastroesophageal Reflux Disease in Children. Turk J Pediatr Dis. 2019;13(3):149-153. https://doi.org/10.12956/tjpd.2018.347