Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease

Hayat, Jamal; Gabieta-Somnez, Shirley; Yazaki, Etsuro; Kang, Jin-Yong; Woodcock, Andrew D.; Dettmar, Peter W.; Mabary, Jerry; Knowles, Charles H.; Sifrim, Daniel

doi:10.1136/gutjnl-2014-307049

Cited by 162 publications

(201 citation statements)

References 33 publications

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“…Saliva testing combined with specific questionnaires on GERD can keep the costs and inconvenience to patients to a minimum. 14 The results obtained in the present study suggested a weak relationship between salivary pepsin concentration and DIS. In our study, we confirmed previous findings on the lack of correlation between salivary pepsin concentration and total esophageal acid exposure.…”

Section: Discussioncontrasting

confidence: 49%

“…Saliva pepsin has recently been proposed as a non-invasive diagnostic method for reflux disease. 14 In the current study, we found that healthy volunteers had low pepsin concentrations, suggesting that physiological reflux can bring small amounts of pepsin into the oral cavity. Patients with reflux-related symptoms (NERD and HO) have higher pepsin concentrations compared with the FH and healthy volunteer groups.…”

Section: Discussionmentioning

confidence: 47%

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Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

Sifrim

Xie

et al. 2017

J Neurogastroenterol Motil

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Background/AimsIncreased salivary pepsin could indicate an increase in gastro-esophageal reflux, however, previous studies failed to demonstrate a correlation between salivary pepsin concentrations and 24-hour esophageal acid exposure. This study aims to detect the salivary pepsin and to evaluate the relationship between salivary pepsin concentrations and intercellular spaces (IS) in different gastroesophageal reflux disease phenotypes in patients. MethodsA total of 45 patients and 11 healthy volunteers were included in this study. All subjects underwent upper gastrointestinal endoscopy, 24-hour ambulatory multichannel impedance-pH (MII-pH) monitoring, and salivary sampling at 3-time points during the 24-hour MII-pH monitoring. IS were measured by transmission electron microscopy, and salivary pepsin concentrations were determined by enzyme-linked immunosorbent assay. ResultsThe IS measurements were greater in the esophagitis (EE), non-erosive reflux disease (NERD), and hypersensitive esophagus (HO) groups than in the functional heartburn (FH) and healthy volunteer groups, and significant differences were indicated. Patients with NERD and HO had higher average pepsin concentrations compared with FH patients. A weak correlation was determined between IS and salivary pepsin among patients with NERD (r = 0.669, P = 0.035). ConclusionsWe confirmed the presence of a higher level of salivary pepsin in patients with NERD than in patients with FH. Salivary pepsin concentrations correlated with severity of mucosal integrity impairment in the NERD group. We suggest that in patients with NERD, low levels of salivary pepsin can help identify patients with FH, in addition the higher the pepsin concentration, the more likely the severity of dilated IS.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 47%

Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

Sifrim

Xie

et al. 2017

J Neurogastroenterol Motil

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“…We did not evaluate the presence of gastro-oesophageal reflux in the patients with gastroparesis. However, the methods used to diagnose gastro-oesophageal reflux have only moderate sensitivity/specificity and can be invasive and expensive [40] so, similar to previous studies [16], we assumed that with the criteria used for the gastroparesis definition we would find an association with post-lung-transplant respiratory infections. Finally, the small sample size may have led to a type II error and may preclude some statistical comparisons.…”

Section: Discussionmentioning

confidence: 60%

Ventilator-associated respiratory infection following lung transplantation

et al. 2014

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The medical records of 170 adult patients who underwent lung transplantation between January 2010 and December 2012 were reviewed to assess the incidence, causative organisms, risk factors and outcomes of post-operative pneumonia and tracheobronchitis. 20 (12%) patients suffered 24 episodes of ventilator-associated pneumonia. The condition was associated with mean increases of 43 days in mechanical ventilation and of 35 days in hospital stay, and significantly higher hospital mortality (OR 9.0, 95% CI 3.2-25.1). Pseudomonas aeruginosa (eight out of 12 patients were multidrug-resistant) was the most common pathogen, followed by Enterobacteriaceae (one out of five patients produced extended-spectrum β-lactamases). Gastroparesis occurred in 55 (32%) patients and was significantly associated with pneumonia (OR 6.2, 95% CI 2.2-17.2). Ventilator-associated tracheobronchitis was associated with a mean increase of 28 days in mechanical ventilation and 30.5 days in hospital stay, but was not associated with higher mortality (OR 1.2, 95% CI 0.4-3.2). Pseudomonas aeruginosa (six out of 16 patients were multidrug resistant) was the most common pathogen, followed by Enterobacteriaceae (three out of 14 patients produced extended-spectrum β-lactamase). Patients with gastroparesis also had more episodes of ventilator-associated tracheobronchitis (40% versus 12%, p<0.001).In conclusion, ventilator-associated pneumonia following lung transplantation increased mortality. Preventing gastroparesis probably decreases the risk of pneumonia and tracheobronchitis. Multidrugresistant bacteria frequently cause post-lung-transplantation pneumonia and tracheobronchitis. @ERSpublications VAP following lung transplantation increases mortality and gastroparesis increases the incidence of VAP

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“…More recently Hayat et al [119] compared the PEPtest with MII-pH and showed a higher prevalence and concentration of salivary pepsin in patients with GERD or HE, compared with patients with FH and healthy controls. The authors suggested that salivary pepsin might complement questionnaires in the office-based diagnosis of patients with GERD-related symptoms.…”

Section: Pep-testmentioning

confidence: 99%

Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

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Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry.

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Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease

Abstract: In patients with symptoms suggestive of GORD, salivary pepsin testing may complement questionnaires to assist office-based diagnosis. This may lessen the use of unnecessary antireflux therapy and the need for further invasive and expensive diagnostic methods.

Cited by 162 publications

References 33 publications

Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

Ventilator-associated respiratory infection following lung transplantation

Esophageal testing: What we have so far

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