Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?

Abstract

Salivary pepsin may be used as a screening adjunct to supplement the RFS in the clinical workup of patients with extra-oesophageal symptoms and upper respiratory tract presentations of reflux.

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

“…The pepsin immunoassay has been adapted as a lateral flow–based test (Peptest) with results available within minutes . According to the meta‐analysis performed by Wang et al, diagnostic values of pepsin detection varied markedly in studies involving different study designs . The heterogeneity of the studies included sample size, diagnostic criteria (pH monitoring/symptoms/signs), assay type (Peptest vs. others), timing of the collection of saliva/sputum, number of pepsin tests performed, and pepsin concentration cutoff values among other factors.…”

“…23 According to the meta-analysis performed by Wang et al, 24 diagnostic values of pepsin detection varied markedly in studies involving different study designs. [25][26][27][28][29] The heterogeneity of the studies included sample size, diagnostic criteria (pH monitoring/symptoms/signs), assay type (Peptest vs. others), timing of the collection of saliva/sputum, number of pepsin tests performed, and pepsin concentration cutoff values among other factors. The team concluded that current evidence for salivary pepsin use is insufficient, and that further investigations are required.…”

Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24‐hour esophageal impedance/pH monitoring in pediatric patients

“…Gastro‐esophageal reflux is common in infants and children and can be assessed using diagnostic tests such as esophageal pH monitoring and MII/pH . Salivary pepsin has been studied as a potential noninvasive diagnostic method for gastric reflux in adults and children . Because pepsin is normally produced only by gastric chief cells in the stomach and is absent from the oropharynx, the presence of pepsin in the saliva is evidence that a gastro‐esophageal reflux event has reached the oropharynx.…”

“…Measurement of gastric pepsin 3b (pepsin A‐4) in the oropharynx has been studied as a noninvasive method to detect oropharyngeal reflux in both adults and children . Because pepsin A is normally found only in gastric juice, it has been hypothesized that GER events positively correlate with the presence of oropharyngeal pepsin .…”

“…Measurement of gastric pepsin 3b (pepsin A-4) in the oropharynx has been studied as a noninvasive method to detect oropharyngeal reflux in both adults and children. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Because pepsin A is normally found only in gastric juice, it has been hypothesized that GER events positively correlate with the presence of oropharyngeal pepsin. 8 To test this hypothesis, we analyzed individual saliva samples collected at varying time periods following impedance-detected GER episodes for the presence of gastric pepsin Additionally, we used validated GERD questionnaires 19,20 to objectively assess clinical symptoms in all subjects.…”