Pepsin and oropharyngeal pH monitoring to diagnose patients with laryngopharyngeal reflux

Weitzendorfer, Michael; Antoniou, Stavros A.; Schredl, Philipp; Witzel, Kai; Weitzendorfer, Isabella C; Majerus, Alexandra; Emmanuel, Klaus; Koch, Oliver

doi:10.1002/lary.28320

Cited by 60 publications

(59 citation statements)

References 34 publications

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“…This is probably due to the close proximity of the monitor sensor to the oral pharynx/oral cavity, which is a short distance for the refluxate to travel from laryngopharynx to the oral cavity. Numerous investigations in adults have clearly demonstrated that salivary pepsin A associated with MII‐pH probe detected laryngopharyngeal reflux 21‐23 . The role of saliva pepsin A in diagnosing gastro‐oesophageal reflux needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Salivary pepsin A detection related to gastro‐oesophageal reflux episodes in children undergoing impedance probe monitoring

Haddad

Shaffer

et al. 2020

Acta Paediatrica

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Aim: Gastro-oesophageal reflux is routinely diagnosed with invasive intraluminal impedance pH probe monitoring. This study aimed to determine whether gastric pepsin A detected in saliva of children correlates with gastro-oesophageal reflux. Methods: Patients undergoing probe monitoring were prospectively recruited between 2014 and 2016 at a paediatric hospital. Standard impedance and demographic data were obtained from electronic medical records. Salivary samples were collected during impedance and measured for gastric pepsin A with an enzyme-linked immunosorbent assay. Impedance probe and pepsin data were analysed and compared for correlation. Results: From 52 enrolled subjects, 28 males and 24 females with mean age 8.0 ± 5.9 and range 0.58-18.0 years, 417 salivary samples were collected. Positive pepsin was found in 14% of samples and 48% patients. The sensitivity of pepsin A in predicting an abnormal impedance was 43% and specificity, 50%. Among pepsin A positive samples, 72% corresponded with a gastro-oesophageal reflux episode. Pepsin peak levels significantly correlated with acidic reflux. Conclusion: Pepsin A was presented in saliva of children undergoing gastro-oesophageal reflux disease investigation. Positive pepsin A was associated with a gastrooesophageal reflux episode, and its peak value correlated with acidic reflux. Salivary pepsin as a marker for gastro-oesophageal reflux needs further investigation.

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Section: Discussionmentioning

confidence: 99%

“…Numerous investigations in adults have clearly demonstrated that salivary pepsin A associated with MII-pH probe detected laryngopharyngeal reflux. [21][22][23] The role of saliva pepsin A in diagnosing gastro-oesophageal reflux needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

Salivary pepsin A detection related to gastro‐oesophageal reflux episodes in children undergoing impedance probe monitoring

Haddad

Shaffer

et al. 2020

Acta Paediatrica

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“…Other studies evaluated the diagnostic value of the Peptest compared to that of MII-pH or pH monitoring [6,14,15]. However, all those studies used the diagnostic criteria for GERD, not LPR.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux

Zeleník

Hránková

Vrtková

et al. 2021

JCM

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Background: The PeptestTM is a non-invasive diagnostic test for measuring the pepsin concentration in saliva, which is thought to correlate with laryngopharyngeal reflux (LPR). The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR. Methods: Patients with suspected LPR were examined with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), fasting Peptest, and MII-pH monitoring. We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Peptest, RSI, and RFS based on the threshold of one and six hypopharyngeal reflux episodes. Results: Altogether, the data from 46 patients were analyzed. When one hypopharyngeal reflux episode was used as a diagnostic threshold for LPR, the accuracy, sensitivity, specificity, PPV, and NPV were, respectively, as follows: 35%, 33%, 100%, 100%, and 3%, for the Peptest; 39%, 40%, 0%, 95%, and 0%, for the RSI; and 57%, 58%, 0%, 96%, and 0%, for the RFS. The accuracy, sensitivity, specificity, PPV, and NPV of the Peptest for diagnosing gastroesophageal reflux disease (GERD) were 46%, 27%, 63%, 40.0%, and 48%, respectively. Conclusions: A positive Peptest is highly supportive of a pathological LPR diagnosis. However, a negative test could not exclude LPR.

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“…Several studies suggest that pepsin can be used as a reliable marker for the diagnosis of LPR; however, the accuracy, timing, and threshold values of pepsin test remain open questions [ 40 , 41 ]. Recently, a prospective study proposed a salivary pepsin cut-off value as an alternative tool for diagnosis of LPR [ 42 ]. The role of lacrimal pepsin test should be further investigated in a prospective study with a larger population of LPR patients included with the gold standard tests (pH throughout 24 h monitoring), in order to verify the role of pepsin as an additional tool for LPR diagnosis and its role in PROD syndrome.…”

Section: Discussionmentioning

confidence: 99%

Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux

Plateroti

Sacchetti

Magliulo

et al. 2020

Life

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Background: patients with laryngopharyngeal reflux (LPR) showed detectable levels of tear pepsin that explain the nasolacrimal obstruction. The purpose of this study was to determine whether patients with LPR show ocular surface changes and to investigate the relationship between lacrimal pepsin concentration and ocular alterations. Methods: Fifty patients with positive endoscopic signs for LPR and an equal or higher score of 13 and 7 for Reflux Symptom Index and Reflux Finding Score were enrolled. Twenty healthy patients with no reflux disease and dry eye were included as the control group. After evaluation of ocular discomfort symptoms, the tear break-up time test, corneal staining, and tear sampling were performed. Tear pepsin levels were measured using Pep-testTM kit. Results: Patients with LPR showed ocular surface changes including epithelial damage (48%) and impairment of lacrimal function (72%). Tear pepsin levels were detectable in 32 out of 50 (64%) patients with LPR (mean ± SD: 55.4 ± 67.5 ng/mL) and in none of the control subjects. Most of the LPR patients complained of ocular discomfort symptoms, including itching (38%), redness (56%), or foreign body sensation (40%). Tear pepsin levels were significantly correlated with the severity of LPR disease and with ocular surface changes. Conclusions: A multidisciplinary approach, including ophthalmological evaluation, should be considered in order to improve the management of patients with LPR.

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Pepsin and oropharyngeal pH monitoring to diagnose patients with laryngopharyngeal reflux

Cited by 60 publications

References 34 publications

Salivary pepsin A detection related to gastro‐oesophageal reflux episodes in children undergoing impedance probe monitoring

Salivary pepsin A detection related to gastro‐oesophageal reflux episodes in children undergoing impedance probe monitoring

Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux

Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux

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