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G131 FLEXIBLE BRONCHOSCOPY AND OESOPHAGEAL PH MONITORING IN CHILDREN NEWLY DIAGNOSED WITH CYSTIC FIBROSIS
S. Sukhani, T. Hiliard, J. Francis, M. Rosenthal, I. Balfour-Lynn, A. Bush, J. Davies.Royal Brompton and Harefield NHS Trust, London, UK
Background: Previous studies have reported significant rates of infection in infants and young children with cystic fibrosis (CF). Based on this evidence, in 2003 we changed our clinical practice to perform routine flexible bronchoscopy (FOB) in children with CF shortly after diagnosis. We also used this opportunity to place an oesophageal pH probe. The aims of this study were to determine whether there was an increased microbiological yield using FOB compared with non-invasive techniques, and to assess the prevalence of gastroesophageal reflux (GOR) in these children.
Method: A retrospective case note review using bronchoscopic records, our CF patient database, computerised microbiology records, and case notes.
Results: Twenty five children were bronchoscoped between March 2003 and May 2005. Median age at CF diagnosis was 5 months (range, prenatal to 10.8 years). Median time to bronchoscopy was 3 months (5 days to 20 months). 19 children had no respiratory symptoms at the time of FOB. Microbiology prior to bronchoscopy had been positive in nine cases (S aureus in 5, Methicillin resistant S aureus (MRSA) in 2, and P aeruginosa in 3 cases). These organisms had been treated appropriately, prior to investigation. A pathogenic organism was found in bronchoalveolar lavage (BAL) in 11 cases (44%) (S aureus in 6, MRSA in 1, P aeruginosa in 5 and Moraxella catarrhalis in 1), eight (73%) of whom were apparently well at the time. The three previously detected P aeruginosa infections had been cleared, making all 5 children with P aeruginosa in BAL new cases; similarly, three of the six cases with S aureus had been previously negative. A pH study was successfully completed in 21 (84%) cases. GOR (pH<4 more than 5% of …