Radka Bittenglová

Use of pepsin detection to identify airways reflux in a range of pulmonary diseases

The diagnostic test Peptest detects pepsin in expectorated saliva and is established as a quick and easy measure of the reflux of gastric contents responsible for gastro-oesophageal reflux disease and extraoesophageal reflux into the laryngopharynx (1, 2). There is evidence that reflux into the airways (lower and upper and lungs) is responsible for aetiology or exacerbation of a range of respiratory conditions (3–5). We hypothesised that detection of pepsin using Peptest could provide objective evidence of a contribution of airways reflux in the pathology of a range of pulmonary diseases. In this pilot investigation, Peptest was used in patients presenting to the department of Pneumology and Physiology at a teaching hospital in the Czech Republic. A saliva sample was collected (in citric acid) and applied to a Peptest diagnostic test (for Methods see ref (1); www.peptest. co.uk). The lower limit of detection is 16 ng/mL. All samples were tested on site at Charles University and rated as either positive, weak positive or negative. Our study assessed 352 patients with a range of respiratory/pneumological diseases for the presence of pepsin in a single expectorated saliva sample, as an indicator of reflux. 283 patients (80%) were shown to be pepsin positive (Table 1). There were large groups of patients presenting with bronchial asthma, chronic cough (CC), idiopathic pulmonary fibrosis (IPF), progressive sarcoidosis, exogenic allergic alveolitis, chronic obstructive pulmonary disease (COPD) and a small cohort of cystic fibrosis (CF) patients. There was a high rate of detection of pepsin by Peptest in these patients ranging from 74% to 89% (Table 1). The conditions in which we showed with the greatest coexistence of reflux were IPF (89%) and CF (86%; although only n 5 7). The data presented in this study were comparable to previous Peptest pepsin detection studies which provide additional evidence to the role of pepsin and reflux in these lung diseases.

EMPIRE Registry, Czech Part: Impact of Demographics, Pulmonary Function and HRCT on Survival and Clinical Course in Idiopathic Pulmonary Fibrosis

Prognostic factors of idiopathic pulmonary fibrosis (IPF) currently recognized include changes in vital capacity and radiologic findings. However, most of the prognostic studies in IPF are based on clinical studies with preselected IPF populations. Therefore, we decided to analyze the factors influencing IPF prognosis based on the real‐practice data from our IPF registry.