ABSTRACT
Theophylline, caffeine, chocolate, and a variety of other substances decrease lower esophageal sphincter pressure and predispose to Gastroesophageal reflux (GER). Laryngospasm due to direct contact of gastric acid with the larynx has been implicated in the pathogenesis of apneic episodes associated with GER. The clinical picture of GER can be quite variable and depends on the frequency and severity of the reflux episodes. The examination of tracheal and bronchoalveolar fluid for lipid-laden macrophages has been suggested as a potentially useful test in the diagnosis of aspiration secondary to GER. Lipid-laden macrophages are encountered more often, in higher numbers, and contain more fat in patients who aspirate than in patients whose lung disease is not due to aspiration. The treatment of GER is directed to the prevention of the sliding of stomach contents into the esophagus and decreasing the risk of esophagitis and aspiration.
