Pepsin: biomarker, mediator, and therapeutic target for reflux and aspiration

Johnston, Nikki; Dettmar, Peter W.; Ondrey, Frank G.; Nanchal, Rahul; Lee, Sang Hyuk; Bock, Jonathan M.

doi:10.1111/nyas.13729

Cited by 34 publications

(31 citation statements)

References 52 publications

(104 reference statements)

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“…Thus, saliva samples should be obtained soon after reflux events to detect the pepsin (16) . Inappropriate timing can reduce real-life sensitivity of the Peptest though it has high technical sensitivity (32) . Reflux appears mostly after meals, and corresponding symptoms of GERD is significantly highest 1 to 2 hours post-prandially (31) .…”

Section: Discussionmentioning

confidence: 99%

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

Katle¹,

Hatlebakk²,

Omdal³

et al. 2019

RHINOL

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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.

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Section: Discussionmentioning

confidence: 99%

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

Katle¹,

Hatlebakk²,

Omdal³

et al. 2019

RHINOL

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“…It is important to note that the approach of Cuomo et al (2008) [15] is more invasive but is able to measure mass reflux of liquid and gas. While the authors still believe that pepsin is a rational biomarker to test for reflux in the upper aerodigestive tract, further work to characterise when or how gastric reflux may occur around individual meals and for how long it takes for pepsin and other refluxate to be cleared from the oral cavity is still required [29]. One approach to better understand periprandial reflux could include saliva sampling over a longer time period and more frequently around a meal, with additional sampling at other times during the day.…”

Section: Discussionmentioning

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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“…Pepsin is the key aggressive enzyme in the gastric juice and is a vital biomarker used in the diagnosis of GERD …”

Section: Introductionmentioning

confidence: 99%

Validation in China of a non‐invasive salivary pepsin biomarker containing two unique human pepsin monoclonal antibodies to diagnose gastroesophageal reflux disease

Wang

Yang

Chen

et al. 2019

J of Digest Diseases

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ObjectivesPeptest is a new non‐invasive reflux diagnostic test based on lateral flow technology that containing two highly specific human pepsin monoclonal antibodies for detecting pepsin, a biomarker for reflux disease. The primary aim of this multicenter clinical study was to validate the efficacy of Peptest in patients diagnosed with gastroesophageal reflux and healthy controls in China.MethodsPatients with suspected gastroesophageal reflux underwent an endoscopy and were classified into non‐erosive reflux disease and erosive esophagitis subgroups. A healthy control group was also recruited. All participants were given a reflux disease questionnaire—patients scoring greater than 12 and controls scoring zero. All participants provided a postprandial saliva sample and most patients gave an additional post‐symptom sample for pepsin analysis.ResultsAltogether 1032 participants aged between 19 and 78 years were recruited. They consisted of 488 patients with non‐erosive reflux disease, 221 with erosive esophagitis and 323 healthy controls. The number of postprandial and post‐symptom samples analyzed totaled 1031 and 692, respectively. The results across all centers showed an overall pepsin‐positive sensitivity of 85%, a specificity of 60%, a positive predictive value of 82%, a negative predictive value of 65% and a positive likelihood ratio of 2.12.ConclusionThe sensitivity of Peptest was high, but the specificity achieved in some centers was low, resulting overall in only a moderate specificity. Further diagnostic investigative studies are warranted.

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Pepsin: biomarker, mediator, and therapeutic target for reflux and aspiration

Cited by 34 publications

References 52 publications

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

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

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

Validation in China of a non‐invasive salivary pepsin biomarker containing two unique human pepsin monoclonal antibodies to diagnose gastroesophageal reflux disease

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