Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux – a prospective comparative study

Šereg-Bahar, Maja; Jerin, Aleš; Janša, Rado; Štabuc, Borut; Boltežar, Irena Hočevar

doi:10.1111/coa.12358

Cited by 93 publications

(113 citation statements)

References 19 publications

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“…It is likely that the sensitivity of salivary pepsin testing could be improved by increasing the frequency of sampling and sampling when symptomatic. Previous studies have shown that patients with proximal reflux as defined by oesophageal pH or impedance testing have higher levels of pepsin in their saliva [24,33].…”

Section: Discussionmentioning

confidence: 99%

“…Pepsin has been identified in the sputum and bronchoalveolar lavage fluid of patients with chronic cough and LPR [6,20], and it has been used to indicate aspiration in patients with lung allografts [21] and the effectiveness of anti-reflux surgery [22]. Salivary pepsin has a moderate sensitivity and specificity for the diagnosis of gastrooesophageal reflux disease in patients with heartburn [23], and its association with scores obtained by clinical diagnostic tools such as the RSI and RFS has been investigated only in smaller studies to date [24,25].…”

Section: Introductionmentioning

confidence: 99%

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Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?

Spyridoulias

Lillie

Vyas

et al. 2015

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?

Spyridoulias

Lillie

Vyas

et al. 2015

Respiratory Medicine

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“…Pepsins are major proteolytic enzymes present in the gastric juices produced by the gastric chief cells and hence can only occur in saliva as a result of gastric contents reaching the oral cavity [21]. It appears that gastro-oesophageal reflux disease patients have higher [pepsin] saliva than healthy individuals, possibly due to more frequent or larger volumes of refluxate reaching the oral cavity in the disease condition [22,23]. Pepsin therefore seems an ideal, acute biomarker of reflux events and the authors hypothesise that higher concentrations of pepsin will be found in saliva if the intake of carbonated beverages or other "refluxogenic" food items has caused the gastric contents to reach the oral cavity.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Acute Effects of Carbonated Beverage Consumption on Symptoms and Objective Markers of Gastric Reflux

Lim

2018

Gastrointestinal Disorders

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Previous studies have suggested that carbonated beverages may cause gastro-oesophageal reflux. Pepsin (the major enzyme secreted by the stomach) has been suggested to be an objective, acute marker of a reflux event. This pilot study aimed to investigate whether intake of carbonated beverages could affect pepsin concentration in saliva or reflux symptoms. This was assessed by a randomised, crossover trial where participants consumed 330 mL of beverage (carbonated cola, degassed cola or water) at separate visits. Saliva samples and symptom questionnaires were collected at baseline and over the 30 min postprandial period. Pepsin was detected in all saliva samples. No difference was found in the salivary pepsin concentrations between treatments at all time points. There were significantly higher scores (p > 0.05) for feelings of fullness, heartburn, urge to belch and frequency of belches after ingestion of carbonated cola than degassed cola and water. The ingestion of carbonated beverages did not appear to increase postprandial pepsin concentration in saliva compared to other beverages but did evoke higher levels of reflux-related symptoms such as fullness, heartburn and belching. This suggests carbonated beverages may cause symptoms associated with reflux but do not drive detectable levels of gastric juice to reach the oral cavity.

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“…Salivary pepsin has been proposed as a promising biomarker 7,8 . Pepsin is a proteolytic enzyme produced in the stomach, so its presence in the oropharynx and tracheobronchial tree suggests reflux and resultant aspiration.…”

mentioning

confidence: 99%

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease

Amirault

Mitchell

et al. 2016

The Journal of Pediatrics

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Objectives To determine the sensitivity of salivary pepsin compared with multichannel intraluminal impedance with pH testing (pH-MII), endoscopy, and gastroesophageal reflux disease (GERD) questionnaires. Study design We prospectively recruited 50 children from Boston Children’s Hospital, who were undergoing pH-MII to evaluate for GERD. Patients completed 24 hour pH-MII testing, symptom and quality of life questionnaires, and provided a saliva specimen which was analyzed using the PepTest® lateral flow test. A subset of patients also underwent bronchoscopy and esophagogastroduodenoscopy. ROC analyses were performed to determine the sensitivity of salivary pepsin compared with each reference standard. Results 21 patients (42%) were salivary pepsin positive, with median concentration of pepsin in the saliva 10 ng/mL (IQR 10 – 55). There was no significant difference in the distributions of acid, nonacid, total reflux episodes, full column reflux or any other reflux variable in patients that were pepsin positive compared with pepsin negative (p>0.5). There was no significant correlation between the number of reflux episodes and pepsin concentrations (p>0.1). There was no positive relationship between salivary pepsin positivity, any extraesophageal symptoms or quality of life scores, or inflammation on bronchoscopy or esophagogastroduodenoscopy (p>0.3). Conclusions Salivary pepsin measurement has a low sensitivity for predicting pathologic gastroesophageal reflux in children.

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Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux – a prospective comparative study

Abstract: The study results show that the levels of total pepsin and bile acids in saliva are significantly higher in patients with LPR than in the controls, thus suggesting this as a useful tool in the diagnosis of LPR and particularly biliary LPR.

Cited by 93 publications

References 19 publications

Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?

Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?

Assessment of the Acute Effects of Carbonated Beverage Consumption on Symptoms and Objective Markers of Gastric Reflux

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease

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