Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Abstract

Background/AimsTo determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. MethodsOverall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES). ResultsCompared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett's esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002). ConclusionsSalivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency. (J Neurogastroenterol Motil 2020;26:74-84)

Can We Apply the Salivary Pepsin Test for Patients With Gastroesophageal Reflux Disease in Primary Practice?

“…The study showed that salivary pepsin concentration was higher in erosive esophagitis, nonerosive reflux disease (NERD), and extraesophageal symptoms compared than healthy controls. 1 No significant difference was found in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression (GERD-AD) compared to healthy controls. 1 Proton pump inhibitors reduced salivary pepsin concentration in patients with NERD and extraesophageal symptoms.…”

“…1 No significant difference was found in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression (GERD-AD) compared to healthy controls. 1 Proton pump inhibitors reduced salivary pepsin concentration in patients with NERD and extraesophageal symptoms. 1 Their application of salivary pepsin to patients with GERD and GERD related diseases increase our understanding of its diagnostic role.…”

“…1 Proton pump inhibitors reduced salivary pepsin concentration in patients with NERD and extraesophageal symptoms. 1 Their application of salivary pepsin to patients with GERD and GERD related diseases increase our understanding of its diagnostic role. However, I have several concerns about this study.…”

“…TO THE EDITOR: I read the original article by Wang et al 1 regarding salivary pepsin as an intrinsic marker for diagnosis of gastroesophageal reflux disease (GERD). The study showed that salivary pepsin concentration was higher in erosive esophagitis, nonerosive reflux disease (NERD), and extraesophageal symptoms compared than healthy controls.…”

The Association of Pepsin and Reflux in US Individuals Self-diagnosing their Reflux like Symptoms

“…6 Pepsin is present in gastric juice therefore, the presence of pepsin within the airways and salivary secretions makes pepsin an excellent biomarker for gastric reflux. [7][8][9] A need for a less invasive, rapid and cost-effective diagnostic test which is easily accessible to clinicians and more importantly for individuals to access for selfdiagnosing their reflux related symptoms led to the development of Peptest. Peptest uses lateral flow technology which contains two unique human pepsin monoclonal antibodies, one to detect pepsin and the other to capture pepsin.…”