Nasal and salivary pepsin as a biomarker for gastroesophageal reflux in chronic rhinosinusitis

Abstract

Background: Gastro-esophageal reflux (GER) may be a contributing factor for some patients with chronic rhinosinusitis (CRS). The aim of the present study was to investigate if Peptest, an immunoassay for pepsin detection, could be used as a biomarker for GER in CRS. Methodology: Peptest was used to analyse 3 saliva and 3 nasal samples for pepsin A in 62 CRS-patients and 62 age and gender matched healthy controls. The results were correlated to 24-hour impedance pH-monitoring and symptom questionnaires. Results: Patients with CRS did not have more abnormal Peptest measures compared to healthy controls, 39 patients and 48 controls, respectively. The presence of abnormal Peptests did not correlate to proximal reflux in CRS-patients. Patients with high GerdQ scores did not have more positive Peptests than those without. Conclusions: These results question the value of Peptest as screening tool for GER in CRS.

Association between Gastroesophageal Reflux Disease and Chronic Sinusitis: Salivary and Nasal Pepsin as a Biomarker

“…Our data showed a little difference in nasal and salivary pepsin between CRS-and controls and the insignificant difference in salivary and nasal pepsins' positivity, maybe in line with Katle et al [23] , though the results made due to the limited sensitivity and specificity of the Peptest.…”

“…Also, pepsin in the nasal sample showed positivity only in the second and third samples in the CRS group than controls; they showed a statistically significant difference. This was parallel to Katle et al [23] , who stated that saliva or nasal secretions of patients with CRS did not have more pepsin when Peptest measured it in comparing their results to healthy controls. They postulated that CRS people with anomalous proximal reflux did not have more positive samples than people without reflux for Peptest.…”

“…In contrast to these results, Katle et al [23] found a lower pepsin concentration in patients than controls, and they explained this by GER inducing hypersalivation that may dilute the pepsin concentration in those patients [29] .…”

“…This study aims to evaluate nasal and salivary pepsin as a biomarker for GER in CRS patients. We chose two groups, patients and controls, who were matched in age and sex, which coincided with previous studies [22][23] . CRS risk factors such as BMI, smoking, diabetes mellites, and allergy showed a significant difference in the patient group than the control one.…”

Nasal pepsin A

“…Other studies have shown that proton pump inhibitor therapy improves reflux symptoms in CRS patients in 79-88% of cases (Beule, 2015). A recent study from Sweden showed that there was a less significant amount of pepsin difference in CRS patients (67.5%) compared to ordinary people (65.4%) through the detection of pepsin in saliva (p=1.00) (Katle et al, 2019). Based on these previous studies, this study was conducted to explain the correlation between CRS and LPR based on nasal pepsin examination.…”