BMT at British Columbia's Children's Hospital (1980-1992) and the. Detroit Medical Center Bone M m w Transplantation (1986-1992) Pro- grams. The diagnosis ...
From bloodjournal.hematologylibrary.org by guest on July 16, 2011. For personal use only.
1995 85: 3763-3765
Association of gastroesophageal reflux with obstructive lung disease in children after allogeneic bone marrow transplantation [letter] KR Schultz, CV Fernandez, DM Israel, F Magee, D Wensley, MA Sargent, E Abella and C Karanes
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From bloodjournal.hematologylibrary.org by guest on July 16, 2011. For personal use only. CORRESPONDENCE
3763
Association of Gastroesophageal Reflux With Obstructive Lung Disease in Children After Allogeneic Bone Marrow Transplantation To the Editor: We recently rePofled a relatively high cumulative incidence (26.1 %) of obstructive lung disease (OLD) in children after allegeneic bone marrow transplantation (BMT).' OLD in these children, histologically consistent with bronchiolitis obliterans, may beassoci-
ated with severe respiratory insufficiency, leading to at death in least 30% of patients. Understanding factors that are associated with OLD in these children may contribute to improved therapy and survival. Gastroesophageal reflux (GER) in association with esophageal disease has been postulated as a cause of OLD in BMT patients.I.2 To test this hypothesis, we evaluated children with irreversible OLD for abnormal GER.
From bloodjournal.hematologylibrary.org by guest on July 16, 2011. For personal use only. CORRESPONDENCE
3764
Table 1. Evaluation for Abnormal GER in Children With OLD After Allogeneic BMT Patient No. ~~
Vomiting pH
Probe
Endoscopic Findings
Esophageal Histology
Radiological GER Study
Manometry
Cause of Death
~
Abnormal GER Absent Absent Absent
Abnormal Abnormal Abnormal
Present Present Present Absent Absent
ND
9
Absent
ND
10 11
Absent Present
ND
1 2
3 4* 5
6 7
8 No GER
Abnormal ND ND
Abnormal
Normal
GE junction polyp ND
Esophagitis/ uIcerations/stricture Esophagitis Esophagitisfulcerations Esophagitis Esophageal stricture ND Stricture small intestine Normal Severe esophageal stricture
Esophagatis ND Esophagitis
ND ND ND
ND
Normal
Alive Relapse Respiratory failure
Esophagitis Esophagitis Esophagitis Esophagitis ND
Abnormal Abnormal Abnormal Abnormal Normal
ND ND ND ND ND
Respiratory failure Respiratory failure Respiratory failure Alive Alive
Normal
Abnormal
ND
Alive
Normal Normal
Normal ND
ND
Abnormal
Alive Alive
Normal
Abbreviation: ND, not done. * Patient had lipid laden macrophages on bronchial alveolar lavage.
Weidentified 15 childrenwithirreversibleOLDafterallogeneic 3 children without abnormal GER had strictures (1 small intestine BMT at British Columbia's Children's Hospital (1980-1992) and the and 1 esophagus) with normal histology at the time of testing. Ten ProDetroit Medical Center Bone M m w Transplantation (1986-1992) of 11 children studied were able to perform pulmonary function tests grams. The diagnosis of OLD was based oncriteriapreviouslyde(limited to children 25.0 years) and were evaluated at presentation scribed by our group.' Patientsdiagnosed as havingOLDshowed or within 12 months after diagnosis of OLD. Of these children, the no evidence of pulmonary abnormalities before transplantation. These mean FEV, was 40.3% predicted (95% confidence interval [CI], patients had at least one of the following findings, in the absence of 26.7 to 53.9) in abnormal GER patients compared with 53.6% (95% infection: (1) abnormal pulmonary function tests after transplant(FEV, CI, 20.5 to 86.7) in those without ( P = .15), and the mean FEF,,. 4 0 % predicted and FEFrr.7se
