Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

Abstract

Objectives To evaluate the necessity of multiple salivary pepsin tests within a day when diagnosing laryngopharyngeal reflux. Study Design Prospective cohort study. Setting Tertiary hospitals. Methods A total of 138 patients with signs and/or symptoms associated with laryngopharyngeal reflux were included. Salivary pepsin was detected on the day of 24-hour pH monitoring, and the results of salivary pepsin detected once in the morning and multiple times in 1 day were compared with the results of pH monitoring. Results Among the 138 patients, pH monitoring results were positive in 112. Salivary pepsin was positive in 47 cases in the morning, which was not consistent with the results of pH monitoring (kappa value = 0.117). With the pH monitoring results as the standard, the salivary pepsin detected once in the morning had a sensitivity of 38.4% (43/112) and a specificity of 84.6% (22/26) for the diagnosis of laryngopharyngeal reflux. When salivary pepsin was detected multiple times per day, 102 patients tested positive. The consistency with pH monitoring was moderate (kappa value = 0.587). The sensitivity was 86.6% (97/112), and the specificity was 80.8% (21/26). Of the 97 patients with positive results from pH monitoring and salivary pepsin detected multiple times a day, 54 had negative findings for a single detection in the morning, indicating that 55.7% (54/97) of the true positive cases were missed. Conclusion Although a single detection of salivary pepsin in the morning is more economical, the sensitivity is too low, and it is necessary to detect it multiple times a day.

Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux

“…Two pH monitoring probes are located in the lower esophagus and above the upper esophageal sphincter. We placed the laryngopharyngeal pH monitoring probe in the posterior region of the cricoid cartilage under direct electronic laryngoscopy and wrapped it in mucosa 20 . The LPR diagnosis was based on the occurrence of ≥1 acid or nonacid HRE 6 .…”

“…It has also been proposed that saliva samples collected for testing after the appearance of significant reflux symptoms have good diagnostic value 16 . However, some studies have indicated that single tests in the morning are too highly missed to be of good diagnostic value, but that testing at multiple time points during the day (12 tests in total) can significantly improve the diagnostic value 17 . However, some patients complain that collecting 12 saliva samples during the day is a burden.…”

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

“…To date, the pepsin saliva measurement is not ready for clinical application for many reasons [ 84 ]. First, the pepsin saliva concentration may significantly vary throughout the testing day [ 85 , 86 , 87 ]. This variation may be attributed to both physiologic and pathologic modifications of esophageal motility and sphincter tonicity, which may be related to lifestyle, meal composition and autonomic nerve dysfunction (anxiety/stress) [ 85 , 86 , 87 , 88 ].…”

“…First, the pepsin saliva concentration may significantly vary throughout the testing day [ 85 , 86 , 87 ]. This variation may be attributed to both physiologic and pathologic modifications of esophageal motility and sphincter tonicity, which may be related to lifestyle, meal composition and autonomic nerve dysfunction (anxiety/stress) [ 85 , 86 , 87 , 88 ]. Second, the best time of saliva collection, which may be defined as the saliva collection associated with the highest accuracy, sensitivity and positive predictive value pepsin test, remains unknown.…”

“…Second, the best time of saliva collection, which may be defined as the saliva collection associated with the highest accuracy, sensitivity and positive predictive value pepsin test, remains unknown. The fasting collection of saliva appears to be adequate, but studies were only conducted on LPR adults [ 85 , 86 , 87 , 88 , 89 ]. Third, as recently suggested, the mucosa injury may be related to other gastroduodenal enzymes, such as bile acids, trypsin or elastase [ 90 , 91 ].…”