At the International Conference on Oesophageal Atresia in Sydney earlier this year, a paper was presented that questioned whether tracheal pepsin is a marker of reflux aspiration in children with oesophageal atresia.

Oesophageal atresia (OA) is a rare birth defect where the upper part of a baby’s oesophagus doesn’t connect with the lower oesophagus and stomach.

It often happens along with a tracheo-oesophageal fistula (TOF), which is a connection between the lower part of the oesophagus and the trachea that causes air to pass from the windpipe to the oesophagus and stomach, and stomach acid to pass into the lungs.

These are rare conditions that occur in 1 in 2,500 live births. OA is suspected in an infant with excessive salivation (drooling) and in a new-born with drooling that is frequently accompanied by choking, coughing and sneezing.

In the paper “Is tracheal pepsin a marker of reflux aspiration in children with Oesophageal Atresia (OA) – Tracheoesophageal Fistula (TOF)”, Peptest – the non-invasive reflux diagnostic device – was used to monitor the pepsin concentrations in tracheal aspirates from 37 patients aged between 0 to 18 years.

Pepsin was detected in tracheal aspirates of more than one third (35 per cent) of children with OA – TOF in this cohort.

However, before pepsin detection can be claimed to be a useful marker of reflux aspiration in these children it is important to corroborate these interesting but early findings with larger prospective studies. For example, where the results of the pepsin assay (Peptest) are also correlated with results of pH-Impedance testing (an invasive test for detecting aspiration of gastric contents).

Professor Peter Dettmar says: “The importance is that up to now there have been no reflux aspiration diagnostic tests available for this group of difficult to treat and diagnose patients. Now we have Peptest but larger clinical evaluation studies are required. If these studies are successful it will revolutionise reflux aspiration testing in this group of patients.”

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