Rapid salivary pepsin test: Blinded assessment of test performance in gastroesophageal reflux disease

Yüksel, Elif Sarıtaş; Hong, Shih-Kuang S.; Strugala, Vicki; Slaughter, James C.; Goutte, Marion; Garrett, C. Gaelyn; Dettmar, Peter W.; Vaezi, Michael F.

doi:10.1002/lary.23252

Cited by 115 publications

(113 citation statements)

References 21 publications

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“…Pepsin shows proteolytic activity up to a pH of 6 and salivary pepsin tests have shown increased pepsin concentrations in patients with GORD and GORD-related supra-oesophageal pathologies. [31][32][33][34] In a recent ex vivo study the additive erosive effects of pepsin and trypsin on teeth were shown. 35 Further elaboration of the interaction of the erosive effects of acid with other salivary factors is needed.…”

Section: Discussionmentioning

confidence: 99%

Gastro‐oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH‐impedance and endoscopic study

Wilder‐Smith

Materna²,

Martig

et al. 2015

UEG Journal

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Background: Dental erosion is a complication of gastro-oesophageal reflux disease (GORD) according to the Montreal consensus statement. However, GORD has not been comprehensively characterized in patients with dental erosions and pH-impedance measures have not been reported. Objectives: Characterize GORD in patients with dental erosions using 24-h multichannel intraluminal pH-impedance measurements (pH-MII) and endoscopy. Methods: This single-centre study investigated reflux in successive patients presenting to dentists with dental erosion using pH-MII and endoscopy. Results: Of the 374 patients, 298 (80%) reported GORD symptoms <2 per week, 72 (19%) had oesophagitis and 59 (16%) had a hiatal hernia. In the 349 with pH-MII the mean percentage time with a pH <4 (95% CI) was 11.0 (9.3-12.7), and 34.4% (31.9-36.9) for a pH <5.5, a critical threshold for dental tissue. The mean numbers of total, acidic and weakly acidic reflux episodes were 71 (63-79), 43 (38-49) and 31 (26-35), respectively. Of the reflux episodes, 19% (17-21) reached the proximal oesophagus. In 241 (69%) patients reflux was abnormal using published normal values for acid exposure time and reflux episodes. No significant associations between the severity of dental erosions and any reflux variables were found. The presence of GORD symptoms and of oesophagitis or a hiatal hernia was associated with greater reflux, but not with increased dental erosion scores. Conclusions: Significant oligosymptomatic gastro-oesophageal reflux occurs in the majority of patients with dental erosion. The degree of dental erosion did not correlate with any of the accepted quantitative reflux indicators. Definition of clinically relevant reflux parameters by pH-MII for dental erosion and of treatment guidelines are outstanding. Gastroenterologists and dentists need to be aware of the widely prevalent association between dental erosion and atypical GORD.

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Section: Discussionmentioning

confidence: 99%

Gastro‐oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH‐impedance and endoscopic study

Wilder‐Smith

Materna²,

Martig

et al. 2015

UEG Journal

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“…The blue lines are visible on the display because the monoclonal antibody is directly labelled with blue latex beads, which detach at the time of Ag-Ab binding. Saritas Yuksel et al [19] evaluated the PEP-Test (defined as ELISA LFD) in 47 patients using pH-metry as a reference standard. The results were compared with a control population, which underwent only the PEP-Test, which has sensitivity and a specificity of 87% ( Figure 5).…”

Section: Pep-testmentioning

confidence: 99%

“…In this context, the advent of novel esophageal function testing, such as impedance-pH monitoring (MII-pH) and high resolution manometry (HRM), has allowed for relevant progress in the understanding of the pathophysiological mechanisms contributing to the development of GERD and, thereafter, its diagnosis and management. Moreover, the role of new technology to detect laryngopharyngeal reflux (LPR) [16][17][18] , as well as the presence of pepsin in clinical samples [19] , deserves careful consideration. The aim of the present review article is to report on the current literature about recent advances in diagnosing GERD.…”

Section: Introductionmentioning

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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“…This is an innovative diagnostic device, based on immune-enzymatic test (i.e. using monoclonal antibodies) able to detect the presence of pepsin in a saliva sample with a sensitivity and specificity of, respectively, 88 and 87% [17]. It is a rapid and non-invasive test.…”

Section: Introductionmentioning

confidence: 99%

Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptesttm

Gelardi¹,

Eplite²,

Mezzina³

et al. 2017

IJOAOT

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LaryngoPharyngeal Reflux (LPR) is a term recently described, classified among the "extra-esophageal disorders", caused by another pathology called "Gastro-Esophageal Disease" (GED). Pepsin has been recognized as the true marker and the responsible factor of mucosal damage.The clinical-instrumental diagnosis of LPR is mainly based upon video laryngoscopy exam, pH-measuring, pH-impedance measuring, using "score" questionnaires, designed to establish the presence of specific symptoms (Reflux Symptom Index -RSI) and endoscopic signs (Reflux Finding Score -RFS). The evidence of the role of pepsin associated to the LPR helped to develop new technologies, able to detect the presence of that enzyme within the saliva; this device is called Peptest TMThe aim of the present study was to correlate the qualitativequantitative values of salivary pepsin (using Peptest TM ) with symptoms and signs obtained from RSI and RFS. The final goal is to validate this enzyme immunoassay method using LPR diagnostic tools.Seventy-five patients were recruited (41 females, 34 males) aged between 12 and 71 years old, (average age 45 years). All patients performed anamnesis, including food habits analysis, RSI evaluation, rhinofibrolaryngoscopy exam with RFS calculation and Peptest TM.Highly comparable results were obtained in all of the 75 patients undergoing double detection of Peptest TM , with LFD measure (T band intensity) and pepsin concentration (ng/ml).Statistically significant correlation concerning symptoms and saliva pepsin concentration was demonstrated as well as the relationship between objective signs and saliva pepsin concentration. The PeptestTM could become the "Gold standard" in all cases LPR pathology suspicion and may allow revealing the symptoms of that pathology at its early onset, avoiding dealing with more invasive methods and helping to adopt the correct therapeutic follow-up as soon as possible.

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Rapid salivary pepsin test: Blinded assessment of test performance in gastroesophageal reflux disease

Abstract: Rapid LFD for salivary pepsin has acceptable test characteristics in patients with GERD. A positive salivary pepsin test in this group may obviate the need for more expensive diagnostic testing by EGD or pH monitoring.

Cited by 115 publications

References 21 publications

Gastro‐oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH‐impedance and endoscopic study

Gastro‐oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH‐impedance and endoscopic study

Esophageal testing: What we have so far

Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptesttm

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