Diffuse Aspiration Bronchiolitis and Post-gastrectomy Aspiration Pneumonia: Are There Special Forms of Aspiration Pneumonia Due to Aging and Gastrectomy?

Abstract

Aspiration pulmonary diseases can be classified into four categories: aspiration pneumonia, Mendelson’s syndrome, diffuse aspiration bronchiolitis (DAB), and post-gastrectomy aspiration pneumonia (PGAP). The latter two types are regarded as special forms, because they cannot be easily diagnosed and are still underdiagnosed and recognized almost locally in Japan.

DAB is characterized by a chronic inflammatory reaction on recurrent aspirated foreign particles in the bronchioles. Therefore, some of its risk factors, such as neurologic disorders, dementia, cardiovascular diseases, dysphagia, or being bedridden, should be carefully considered. Centrilobular nodular shadows with branching opacities on the chest computed tomography (CT) scan may efficiently diagnose diffuse bronchiolitis. Recurrent bronchorrhea, bronchospasm, or dyspnea episodes are also suggestive of DAB.

Repetitive episodes of productive cough or symptoms consistent with esophageal reflux while sleeping are common in PGAP. Patients with PGAP often develop pyrexia in the following morning. Chest radiographs, or CT scans show mild and/or multiple small infiltrates. Swallowing dysfunction characterized by prolonged latent time for the swallowing reflex may predispose patients with PGAP.

These types of aspiration pneumonia should be carefully considered in order to determine hidden risks of recurrent aspiration and to propose other aspects of management.