Diagnostic Utility of Salivary Pepsin as Compared With 24‐Hour Dual pH/Impedance Probe in Laryngopharyngeal Reflux

Zhang, Michael; Chia, Clemente; Stanley, Claire; Phyland, Debra; Paddle, Paul

doi:10.1177/0194599820951183

Cited by 30 publications

(30 citation statements)

References 22 publications

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“…The factors affecting the results of the salivary pepsin test include the time of detection, the pathologic threshold of pepsin concentration, and the timing 1 . Zhang et al 17 proved that when the pathologic pepsin threshold was 75 ng/mL, the sensitivity of pepsin detection was 57.7% and the specificity was 75.0%. When the threshold was 16 ng/mL, the sensitivity was 76.9% but the specificity was just 25.0%.…”

Section: Discussionmentioning

confidence: 99%

Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

Wang

Nie

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To evaluate the necessity of multiple salivary pepsin tests within a day when diagnosing laryngopharyngeal reflux. Study Design Prospective cohort study. Setting Tertiary hospitals. Methods A total of 138 patients with signs and/or symptoms associated with laryngopharyngeal reflux were included. Salivary pepsin was detected on the day of 24-hour pH monitoring, and the results of salivary pepsin detected once in the morning and multiple times in 1 day were compared with the results of pH monitoring. Results Among the 138 patients, pH monitoring results were positive in 112. Salivary pepsin was positive in 47 cases in the morning, which was not consistent with the results of pH monitoring (kappa value = 0.117). With the pH monitoring results as the standard, the salivary pepsin detected once in the morning had a sensitivity of 38.4% (43/112) and a specificity of 84.6% (22/26) for the diagnosis of laryngopharyngeal reflux. When salivary pepsin was detected multiple times per day, 102 patients tested positive. The consistency with pH monitoring was moderate (kappa value = 0.587). The sensitivity was 86.6% (97/112), and the specificity was 80.8% (21/26). Of the 97 patients with positive results from pH monitoring and salivary pepsin detected multiple times a day, 54 had negative findings for a single detection in the morning, indicating that 55.7% (54/97) of the true positive cases were missed. Conclusion Although a single detection of salivary pepsin in the morning is more economical, the sensitivity is too low, and it is necessary to detect it multiple times a day.

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Section: Discussionmentioning

confidence: 99%

Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

Wang

Nie

et al. 2021

Otolaryngol.--head neck surg.

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“…In recent years, the value of salivary pepsin testing for the diagnosis of LPR has been extensively studied, and an increasing number of studies have shown that salivary pepsin can be used as a specific diagnostic marker for LPR. 8 , 21 , 22 , 23 Our research adopted a new method of detecting pepsin in saliva, 18 and we compared the consistency between the results of MTPSPT with those obtained with the RSI and RFS. The results showed that there was a moderate degree of consistency between the two methods (kappa value = 0.566, p = .00).…”

Section: Discussionmentioning

confidence: 99%

“…The RSI and RFS are noninvasive and convenient, and they are currently the most commonly used screening method. The 24 h MII‐pH method is regarded by many researchers as the gold standard for diagnosing LPR, 1 , 8 but because it is invasive, expensive, and not accepted by some patients, it is only used in a few hospitals. 9 , 10 Empirical therapy commonly involves the administration of proton pump inhibitors (PPIs) for 3–6 months and the assessment of the treatment response.…”

Section: Introductionmentioning

confidence: 99%

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Zhang

et al. 2021

Laryngoscope Investig Oto

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Objective: To study the value of multitime point salivary pepsin testing (MTPSPT) for the diagnosis of laryngopharyngeal reflux (LPR).Study Design: Prospective noncontrolled.Methods: For patients who met the enrollment criteria, the reflux symptom index (RSI) and reflux finding score (RFS) were calculated and salivary pepsin testing was performed. The pepsin test was performed every hour from 7:00 a.m. to 6:00 p.m. by collecting fresh saliva samples. A single positive test result was needed for the diagnosis of LPR. The consistency in the diagnosis of LPR between the two methods was compared with the weighted Cohen's kappa statistic.Results: A total of 204 patients were included. The kappa value between the two methods was 0.566 (p = .00). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MTPSPT were 76.43%, 85.94%, 92.24%, and 62.5%, respectively. We also compared a single pepsin measure at 7 a.m. with the screening results based on the RSI and RFS, and found a much lower kappa agreement value (0.223, p = .00). The sensitivity, specificity, PPV, NPV, and false-negative rate of pepsin testing at 7 a.m. (fasting) were 37.86%, 92.18%, 91.38%, 40.41%, and 58.57%, respectively. Conclusion:The use of the result of a single salivary pepsin test in the morning yields a relatively higher rate of missed diagnosis of LPR, and multitime point testing through a day increased the accuracy and sensitivity of detection of LPR twofold compared to a single morning fasting sample.

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“…According to a recent systematic review, the pooled sensitivity and specificity for the diagnosis of LPR with Peptest ® (>16 ng/mL) were 62% and 74%, respectively [ 83 ]. Zhang et al assessed the sensitivity, specificity, and predictive values of Peptest ® regarding different thresholds of saliva pepsin measurements [ 84 ]. These authors observed that the use of 75 ng/mL in place of 16 ng/mL for the diagnosis of LPR decreased the sensitivity from 76.9% to 57.7%, while the positive predictive value increased from 87% to 93.8% [ 84 ].…”

Section: Perspective Of Ph Study In Otolaryngologymentioning

confidence: 99%

“…Zhang et al assessed the sensitivity, specificity, and predictive values of Peptest ® regarding different thresholds of saliva pepsin measurements [ 84 ]. These authors observed that the use of 75 ng/mL in place of 16 ng/mL for the diagnosis of LPR decreased the sensitivity from 76.9% to 57.7%, while the positive predictive value increased from 87% to 93.8% [ 84 ]. In sum, the pepsin saliva measurement is another diagnostic approach with less reliability than HEMII-pH.…”

Section: Perspective Of Ph Study In Otolaryngologymentioning

confidence: 99%

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Lechien

2022

JCM

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Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

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Diagnostic Utility of Salivary Pepsin as Compared With 24‐Hour Dual pH/Impedance Probe in Laryngopharyngeal Reflux

Cited by 30 publications

References 22 publications

Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

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