The Diagnostic Usefullness of the Salivary Pepsin Test in Symptomatic Laryngopharyngeal Reflux

Barona-Lleo, Luz; Guzmán, Rafael Barona de; Krstulovic, Claudio

doi:10.1016/j.jvoice.2018.07.008

Cited by 26 publications

(31 citation statements)

References 28 publications

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“…25 Salivary pepsin level can quickly distinguish true reflux with non-reflux diseases, and is important for the diagnosis of GERD patients with predominant respiratory symptoms. [14][15][16][17]26 In this study, the positive rate of detecting EES was 68.2%, which was consistent with the observation of a previous study, 24 suggesting that salivary pepsin is of certain diagnostic value for the diagnosis of EES. In addition, the salivary pepsin level and positive rate in the BE group were significantly higher than those in the HC group in the present study, suggesting that pepsin reflux does play a significant role in the process of BE formation.…”

Section: Discussionsupporting

confidence: 91%

“…41,46 The current basic principle of drug therapy against GERD is to reduce gastric acid secretion and indirectly reduce the production of pepsin, thereby reducing the amount of gastric acid and pepsin refluxed to the esophagus, throat and other parts, resulting in significantly reduced clinical symptoms and the mucosa damages to the reflux site in GERD patients. 6,14,15 This study showed that for NERD patients, the positive rate of salivary pepsin test was significantly higher than the pathologic reflux as determined by 24-hour pH monitoring (71.9% vs 43.8%), suggesting that salivary pepsin test can complement or combine with the 24-hour pH monitoring and improve the efficiency in the diagnosis of GERD. A recent study showed that 24-hour pH monitoring was less sensitive in the diagnosis of NERD, 47 which was consistent with our study.…”

Section: Discussionmentioning

confidence: 75%

“…13,14 This detected the presence of pepsin in the saliva, sputum, alveolar lavage fluid and middle ear effusion as a sign of previous reflux events providing a basis for the diagnosis of reflux diseases. [13][14][15][16] The Peptest kit, which contains 2 anti-human pepsin antibodies, using colloidal gold immunochromatography and antigenantibody reaction principles to specifically capture the pepsin in the sample without influence by the pepsin activity, can be used in rapid detection of salivary pepsin concentration (SPC) by using colloidal gold immunochromatography and highly specific antigen-antibody reaction. 13,17 Research on pepsin detection for the diagnosis of GERD and GERD-related disorder is a hot spot nowadays, [13][14][15][16][17] but rarely reported in China.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Lang

et al. 2020

J Neurogastroenterol Motil

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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)

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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

Wang

Lang

et al. 2020

J Neurogastroenterol Motil

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“…A similar positive predictive value was observed for Peptest against symptomatic episodes (69%). Currently, there are well over 100 peer-reviewed publications describing the diagnostic potential of pepsin in LPR [7,19,[49][50][51][52][53][54][55][56][57][58]. Many studies have incorporated the rapid simple pepsin spit saliva test into the battery of diagnostic procedures routinely used in ENT clinics such as questionnaires [36] like the RSI [25] and the RFS [26] together with a flexible transnasal laryngoscope.…”

Section: Discussionmentioning

confidence: 99%

A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients

Dettmar

Watson

McGlashan

et al. 2019

SN Compr. Clin. Med.

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Questionnaires and invasive diagnostic tests are established for diagnosing gastro-esophageal reflux disease (GERD) but shown not to be sensitive or specific for diagnosing laryngopharyngeal reflux (LPR) where vast majority of reflux events are weakly acidic or non-acidic. The research question addressed in the current multicentre study was to determine if the measurement of salivary pepsin is a sensitive, specific and reliable diagnostic test for LPR. Five UK voice clinics recruited a total of 1011 patients presenting with symptoms of LPR and a small group of subjects (n = 22) recruited as asymptomatic control group. Twenty-six patients failed to provide demographic information; the total patient group was 985 providing 2927 salivary pepsin samples for analysis. Study participants provided 3 saliva samples, the first on rising with two samples provided post-prandial (60 min) or post-symptom (15 min). The control group provided one sample on rising and two post-prandial providing a total of 66 samples. Pepsin analysis was carried out using Peptest as previously described. High prevalence of pepsin in patient groups (75%) represents a mean pepsin concentration of 131 ng/ml. The greatest prevalence for pepsin was in the post-prandial sample (155 ng/ml) and the lowest in the morning sample (103 ng/ml). The mean pepsin concentration in the control group was 0 ng/ml. Patients across all 5 clinics showed high prevalence of salivary pepsin (ranging from 69 to 86%), and the overall sensitivity was 76.4% and specificity 100%. Pepsin was shown to be an ideal biomarker for detecting airway reflux and LPR.

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“…The present study differs in several ways from previously meta-analyses and systematic reviews [3,32]. Firstly, we excluded studies on laryngopharyngeal reflux disease (LPRD) [13,18,20–22,25,26]. LPRD is a supra-esophageal form of GERD, which is defined as the back flow of gastric or gastroduodenal contents into the laryngopharynx.…”

Section: Discussionmentioning

confidence: 99%

Pepsin in Saliva as a Diagnostic Marker for Gastroesophageal Reflux Disease: A Meta-Analysis

Guo

Jiang

et al. 2018

Med Sci Monit

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BackgroundGastroesophageal reflux disease (GERD) is very common. Salivary pepsin detection has previously been considered as a method for GERD diagnosis. We performed a meta-analysis to investigate the utility of salivary pepsin assay as a diagnostic tool of GERD.Material/MethodsPubMed, Web of Science, the Cochran Library, and EMBASE (from January 1980 to 23 October 2018) were searched for pepsin in saliva for GERD diagnosis. We summarized the retrieved specificity, sensitivity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves data in the meta-analysis.ResultsIn final analysis, a total of 5 studies were included. The summary sensitivity, specificity, NLR, and PLR were 0.60 (95% CI 0.41–0.76), 0.71 (95% CI 0.51–0.86), 0.56 (95% CI 0.34–0.93), and 2.1 (95% CI 1.1–4.1), respectively. The pooled DOR was 4 (95% CI 1.0–11.0) and area under the ROC was 0.70 (95% CI 0.66–0.74).ConclusionsThe meta-analysis showed that pepsin in saliva has moderate diagnostic value for GERD, and is not as helpful as previously thought.

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The Diagnostic Usefullness of the Salivary Pepsin Test in Symptomatic Laryngopharyngeal Reflux

Cited by 26 publications

References 28 publications

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

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

A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients

Pepsin in Saliva as a Diagnostic Marker for Gastroesophageal Reflux Disease: A Meta-Analysis

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