REVIEW ARTICLE


Gastric Aspiration and Its Role in Airway Inflammation



E.B. Hunt1, 2, A. Sullivan3, J. Galvin3, J. MacSharry3, D.M. Murphy1, 2, *
1 The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
2 The Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
3 The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland


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© 2018 Hunt et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland, Tel: +353 21 492200, Fax: +353 21 4920168; E-mail: Desmond.murphy@hse.ie


Abstract

Gastro-Oesophageal Reflux (GOR) has been associated with chronic airway diseases while the passage of foreign matter into airways and lungs through aspiration has the potential to initiate a wide spectrum of pulmonary disorders. The clinical syndrome resulting from such aspiration will depend both on the quantity and nature of the aspirate as well as the individual host response. Aspiration of gastric fluids may cause damage to airway epithelium, not only because acidity is toxic to bronchial epithelial cells but also due to the effect of digestive enzymes such as pepsin and bile salts. Experimental models have shown that direct instillation of these factors to airways epithelia cause damage with a consequential inflammatory response. The pathophysiology of these responses is gradually being dissected, with better understanding of acute gastric aspiration injury, a major cause of acute lung injury, providing opportunities for therapeutic intervention and potentially, ultimately, improved understanding of the chronic airway response to aspiration. Ultimately, clarification of the inflammatory pathways which are related to micro-aspiration via pepsin and bile acid salts may eventually progress to pharmacological intervention and surgical studies to assess the clinical benefits of such therapies in driving symptom improvement or reducing disease progression.

Keywords: Reflux, Medicine, Inflammation, Lung Injury, Epithelium, Cytokines.