{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:22:12Z","timestamp":1787800932743,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Respiratory Journal"],"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing.<jats:italic>Objectives<\/jats:italic>. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants.<jats:italic>Methods<\/jats:italic>. 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.<jats:italic>Results<\/jats:italic>. Wheezy infants with silent reflux and wheezy infants with typical GERD symptoms but normal MII-pH had significantly higher BAL pepsin compared to healthy control (45.3 \u00b1 8.6 and 42.8 \u00b1 8 versus 29 \u00b1 2.6,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn fontstyle=\"italic\">0.0001<\/mml:mn><\/mml:math>and<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn fontstyle=\"italic\">0.011<\/mml:mn><\/mml:math>, resp.). BAL pepsin had sensitivity (61.7%, 72 %, and 70%) and specificity (55.5%, 52.9%, and 53%) to diagnose GERD associated infantile wheeze compared to abnormal MII-pH, reflux esophagitis, and lipid laden macrophage index, respectively.<jats:italic>Conclusion<\/jats:italic>. A stepwise approach for assessment of GERD in wheezy infants is advised. In those with silent reflux, a trial of antireflux therapy is warranted with no need for further pepsin assay. But when combined MII-pH is negative despite the presence of typical GERD symptoms, pepsin assay will be needed to rule out GERD related aspiration.<\/jats:p>","DOI":"10.1155\/2016\/9480843","type":"journal-article","created":{"date-parts":[[2016,7,19]],"date-time":"2016-07-19T17:02:11Z","timestamp":1468947731000},"page":"1-7","source":"Crossref","is-referenced-by-count":10,"title":["Clinical Utility of Bronchoalveolar Lavage Pepsin in Diagnosis of Gastroesophageal Reflux among Wheezy Infants"],"prefix":"10.1155","volume":"2016","author":[{"given":"Ahmed Fathi","family":"Abdallah","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"El-Desoky","sequence":"additional","affiliation":[{"name":"Allergy, Respiratory, and Clinical Immunology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Fathi","sequence":"additional","affiliation":[{"name":"Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wagdy Fawzi","family":"Elkashef","sequence":"additional","affiliation":[{"name":"Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6359-5572","authenticated-orcid":true,"given":"Ahmed","family":"Zaki","sequence":"additional","affiliation":[{"name":"Allergy, Respiratory, and Clinical Immunology Unit, Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura 35516, 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