Airway reflux

Johnston, Nikki; Ondrey, Frank G.; Rosen, Rachel; Hurley, Bryan P.; Gould, Jon C.; Allen, J.P.; DelGaudio, John M.; Altman, Kenneth W.

doi:10.1111/nyas.13080

Cited by 52 publications

(46 citation statements)

References 54 publications

(114 reference statements)

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“…In that respect, some new noninvasive diagnostic approaches have been developed, such as pepsin detection in saliva samples (Peptest, RD Biomed, Milan, Italy) . This approach was developed according to some studies, which reported that the deposit of pepsin on the laryngopharyngeal mucosa leads to the development of mucosal inflammation and injury and the related symptoms and signs . Peptest (RD Biomed) provides a measurement of the pepsin saliva concentration, which theoretically is correlated with the occurrence of pharyngeal/proximal esophageal reflux episodes within the previous hours .…”

Section: Introductionmentioning

confidence: 99%

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Bobin¹,

Journé

Lechien

2019

The Laryngoscope

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Objective: To investigate the relationship between the laryngopharyngeal reflux (LPR) episodes at the multichannel intraluminal impedance-pH monitoring (MII-pH) and the concentration of pepsin in the saliva of LPR patients.Methods: Patients with LPR were enrolled from the polyclinic of Poitiers, France. Patients benefited from 24-hour MII-pH that allowed a correlation study between reflux episodes and symptoms. Patients reported the occurrence of the critical symptoms during the testing period through a recording device. Simultaneously, they collected a first saliva sample 30 minutes after the symptoms and a second saliva collection a few hours after the first collection. The patient symptoms were assessed with reflux symptom score (RSS). The relationship between pepsin concentration in the saliva, symptoms, and the reflux episode characteristics at the MII-pH was investigated through multiple linear regression.Results: A total of 65 patients with LPR were recruited. The mean concentrations of the first and the second pepsin samples were 92.0 AE 108.1 and 101.8 AE 131.0, respectively. Peptest (RD Biomed, Milan, Italy) was positive in 51 LPR patients (78.5%). Concentrations of both pepsin samples were significantly correlated (P = 0.019). There was no significant association between pepsin concentrations in saliva samples, RSS, key symptoms during the test period, and MII-pH findings.Conclusion: The level of pepsin saliva concentration is not associated with the reflux episodes at the MII-pH. Future studies are needed to better understand the relationship between the extracellular pepsin concentration, mucosal inflammation, and related laryngopharyngeal symptoms.

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Section: Introductionmentioning

confidence: 99%

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Bobin¹,

Journé

Lechien

2019

The Laryngoscope

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“…Vaezi suggested that when treating patients with LPR using a proton pump inhibitor (PPI), treatment should not be preceded by pH monitoring . Recently combined multichannel intraluminal impedance (MII) and pH monitoring (MII–pH) has provided an advance in LPR diagnostics; however, the procedure is still too invasive to be a convenient tool for screening LPR in clinics …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Recently combined multichannel intraluminal impedance (MII) and pH monitoring (MII-pH) has provided an advance in LPR diagnostics; however, the procedure is still too invasive to be a convenient tool for screening LPR in clinics. 7 Based upon a careful study of pH monitoring used to confirm LPR cases, Belafsky et al 8 Symptom Index (RSI), a self-administered nine-item questionnaire that helps physicians assess the severity of a patient's LPR symptoms both before and after treatment. According to their article, patients with an RSI score ≥13 were considered to be potential LPR sufferers.…”

Section: Introductionmentioning

confidence: 99%

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

Wang

Lien²,

Lin

et al. 2018

The Laryngoscope

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Objectives/Hypothesis To evaluate the prediction value of saliva pepsin detection for an 8‐week proton pump inhibitor (PPI) response in patients with a Reflux Symptoms Index (RSI) score ≥13, which indicates possible laryngopharyngeal reflux. Study Design Prospective individual single‐cohort study. Methods Patients were recruited who had experienced chronic laryngopharyngeal symptoms (RSI score ≥13) for more than 3 months after excluding other etiologies. The patients received PPI (40 mg of esomeprazole once daily) treatment for 8 weeks. Prior to treatment, the patients submitted saliva/sputum samples that were collected during the time symptoms were observed. The samples were taken for pepsin detection, and performed using the commercially available Peptest lateral flow device. The association of the Peptest results and PPI response were statistically analyzed with the χ2 test. Results Seventy‐four patients completed the study, and upon completion of PPI treatment, the mean RSI score was significantly reduced from 19.22 ± 5.18 to 8.99 ± 5.69. Forty‐four (59.5%) patients exhibited a good response as defined by an RSI score reduction ≥50%. The results of the Peptest were semiquantitatively graded as 0, 1, 2, 3 (negative, weak positive, moderate positive and strong positive, respectively) based upon the visual intensity of the test sample line as compared to the control line. Twenty‐four patients (32.4%) exhibited grade 3 strong positive results. The Peptest strong positive results (P < .05) were significantly associated with a good PPI response, with the positive predictive value being 79.2%. Conclusions Analysis of strong positive results for pepsin detection in saliva/sputum samples may be a useful, noninvasive method for predicting better PPI response in patients with suspected reflux induced chronic laryngopharyngeal symptoms. Level of Evidence 2 Laryngoscope, 129:709–714, 2019

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“…Laparoscopic Nissen fundoplication is usually reserved for patients with no response to the above treatment options (46). Neuromodulation with amitriptyline or gabapentin has demonstrated success in modifying the cough response in adults (47). …”

Section: Pediatric Gastroenterologist Perspectivementioning

confidence: 99%

Aerodigestive Approach to Chronic Cough in Children

Naime

Batra

Fiorillo

et al. 2018

Curr Treat Options Peds

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Purpose of review: Chronic cough is the most common presenting complaint in a pediatric aerodigestive clinic. The etiology of chronic cough is varied and often includes more than one organ system. This review aims to summarize the current literature for a multidisciplinary approach when evaluating a child with chronic cough. Recent findings: There is very little medical literature focused on a multidisciplinary approach to chronic cough. In the limited data available, multidisciplinary clinics have been shown to be more cost-efficient for the families of children with complex medical problems, and also increase the likelihood of successfully obtaining a diagnosis. Summary: There is no consensus in the literature on how to work-up a child with chronic cough presenting to an aerodigestive clinic. Current studies from these clinics have shown improved outcomes related to cost-effectiveness and identifying definitive diagnoses. Future studies evaluating clinical outcomes are necessary to help delineate the utility of testing routinely performed, and to demonstrate the impact of interventions from each specialty on quality of life and specific functional outcome measures.

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Airway reflux

Cited by 52 publications

References 54 publications

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

Aerodigestive Approach to Chronic Cough in Children

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