Saliva Pepsin Concentration of Laryngopharyngeal Reflux Patients Is Influenced by Meals Consumed Before the Samples

Abstract

Objectives/Hypothesis To assess the impact of diet on the saliva pepsin concentration of patients with laryngopharyngeal reflux (LPR). Study Design Non‐controlled Prospective Study. Methods Patients with positive LPR regarding hypopharyngeal–esophageal impedance‐pH monitoring (HEMII‐pH) were enrolled from three European Hospitals. Patients collected three saliva samples, respectively, in the morning (fasting), and 1 to 2 hour after lunch and dinner. Patients carefully detailed foods and beverages consumed during meals and before the pepsin samples. The 3‐month treatment was based on the association of diet, proton pump inhibitors, alginate, or magaldrate regarding the HEMII‐pH characteristics. Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were used for assessing the pre‐ to posttreatment clinical evolution. The Refluxogenic Diet Score and the Refluxogenic Score of a Dish (RESDI) were used to assess the refluxogenic potential of foods and beverages. The relationship between saliva pepsin concentration, HEMII‐pH, RESDI, RSS, and RSA was investigated through multiple linear regression. Results Forty‐two patients were included. The saliva pepsin concentration of the 24‐hour period of testing was significantly associated with foods and beverages consumed during the testing period and the evening dinner (rs = 0.973, P < .001). RSS and RSA significantly improved throughout treatment. The level of saliva pepsin in the morning was a negative predictive factor of the therapeutic response regarding RSA and RSS (P < .036). Conclusions Foods and beverages may significantly impact the saliva pepsin concentration of patients with LPR. Patients with high‐level saliva pepsin in the morning had lower therapeutic response compared with those with low‐level saliva pepsin. Level of Evidence 4 Laryngoscope, 131:350–359, 2021

Hypopharyngeal‐Esophageal Impedance‐pH Monitoring Profiles of Laryngopharyngeal Reflux Patients

“…In practice, the best time to collect the saliva would be the morning (fasting) regarding the predictive value of saliva pepsin level on the severity of some inflammatory signs (endolaryngeal sticky mucus, RSA laryngeal and total scores) and related symptoms (globus and throat clearing). As suggested in another study, 24 the saliva pepsin concentration in the morning would be more representative of the quantity of deposited pepsin in the upper aerodigestive tract mucosa over the previous 12 to 24 hours.…”

Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux

“…To the best of our knowledge, no previous study has compared the Peptest to MII-pH monitoring based on diagnostic criteria for LPR (i.e., the number of hypopharyngeal reflux episodes) and provided data on diagnostic value of the Peptest. Many factors can influence the results of a comparison between the Peptest and MII-pH monitoring, but two factors are most important: first, the MII-pH protocol, probe placement, and criteria; second, the time of saliva collection for the pepsin analysis and diet within a 24 h period before sample collection [21,22].…”

“…To date, there is no consensus about the best time for collecting the saliva sample. In fact, there is significant heterogeneity among studies concerning the timing of saliva collection, and the results differ among the different studies [21,22]. However, well-designed studies from the last few years have supported the notion that saliva for pepsin examinations should be collected upon waking, and we used this methodology in the present study [16,17,20,22].…”

Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians

“…First, the saliva pepsin concentration would be not correlated with the HEMII-pH findings [ 68 ]. Second, the diet of patients could have a significant impact on the pepsin saliva concentration [ 69 ]. Third, there is no consensus about the best time for saliva collection [ 67 ].…”

“…Third, there is no consensus about the best time for saliva collection [ 67 ]. Some authors supported that pepsin has to be measured upon waking (morning) [ 69 , 70 ], but that has to be confirmed in future studies.…”