Deteksi pepsin pada penderita refluks laringofaring yang didiagnosis berdasarkan reflux symptom index dan reflux finding score

Abstract

Background: It is estimated that more than 50% of patients with voice disorders who come fortreatment are caused by laryngopharyngeal reflux (LPR). LPR has been implicated in the etiology ofmany laryngeal disorders including subglottic stenosis, laryngeal carcinoma, laryngeal contact ulcer,laryngospasm and vocal nodule on the vocal cords. Ambulatory 24 hour double-probe (pharyngeal andesophageal) pH monitoring is the gold standard examination for diagnosing LPR, but it is still far fromideal criteria.The assessment of pepsin in airway secretions could be used as a sensitive diagnosticmarker of LPR because pepsin is not synthesized by any type of airway cells. Purpose: The aim ofthis study was to detect the presence of pepsin on laryingopharyngeal reflux patients which diagnosedbased on reflux symptom index (RSI) dan reflux finding score (RFS) at Wahidin Sudirohusodo Hospital,Makassar. Methods: This is a comparative quantitative study. We performed RSI and RFS examinationson 51 samples, followed by saliva pepsin detection using ELISA method on 48 samples, then analyzed withSpearman’s Rho test. Result: RSI score >13 was found in 48 samples (94,12%) and RFS score >7 wasin 51 samples (100%). Pepsin was detected on all sputum samples, however there was no significant relationship betwen RSI and RFS scoring with the level of pepsin in saliva (p>0.01). Conclusion: Pepsin was detected on saliva of patients with laringopharyngeal reflux who was diagnosed based on RSI andRFS. We concluded that RSI and RFS can be used as diagnostic tools for LPR. Keywords: laringopharyngeal reflux, reflux symptom index, reflux finding score, pepsin Abstrak : Latar belakang: Diperkirakan lebih dari 50% pasien dengan gangguan suara yang datang berobatke dokter THT diakibatkan oleh refluks laringofaring (RLF). Diduga RLF berperan pada patogenesissejumlah kelainan pada laring, termasuk stenosis subglotik, karsinoma laring, laryngeal contact ulcers,laringospasme dan vokal nodul pada pita suara. Pemeriksaan ambulatory 24 hour double-probe pHmonitoring merupakan gold standard untuk mendiagnosis RLF, namun pemeriksaan ini masih jauh darikriteria ideal. Menentukan adanya pepsin pada sekret saluran napas merupakan petanda diagnostik yangsensitif untuk RLF karena pepsin tidak dihasilkan oleh sel apapun dalam saluran napas. Tujuan: Penelitianini bertujuan mendeteksi keberadaan pepsin pada penderita refluks laringofaring yang didiagnosisberdasarkan refluks symptom index (RSI) dan reflux finding score (RFS). Metode: Jenis penelitian iniadalah komparatif kuantitatif. Dilakukan pemeriksaan RSI dan RFS pada 51 percontoh dan dilanjutkandengan pemeriksaan pepsin saliva menggunakan metode ELISA pada 48 percontoh lalu dilakukan ujiSpearman’s Rho. Hasil: Skor RSI >13 sebanyak 48 percontoh (94,12%) dan skor RFS >7 sebanyak 51percontoh (100%). Pepsin terdeteksi pada saliva semua percontoh. Tidak ada hubungan yang bermaknaantara skoring RSI dan RFS dengan kadar pepsin pada saliva (p>0,01). Kesimpulan: RSI dan RFS dapatdigunakan dalam menegakkan diagnosis RLF. Kata kunci: refluks laringofaring, reflux symptom index, reflux finding score, pepsin

Diagnostic of lingual tonsil hypertrophy with lateral soft tissue cervical X-ray on laryngopharyngeal reflux

“…The mean age of LPR respondents in this study was 49.20 years of age with a standard deviation of 10.95 years. This study corresponded with the results of the study by Andriani et al 11 with the age group of 41-50 years as many as 54.9% and Asyari et al 12 which found that 40% were in the 48-57 years of age group. Changes in laryngeal mucosa commonly occur in 40 years of age or older because, in females entering the menopausal age, superficial layer edema causes a decrease of laryngeal mucus production, changes also occur in the epithelial mucosa of the plica vocalis so that the mucous epithelium is thinning and the larynx is susceptible of being exposed to acidic substances which increases the occurrence of LPR.…”

“…Based on sex characteristics in this study, LPR patients were dominantly female, with a number of 23 respondents (76.7%) compared to 7 male respondents (23.3%). This findings corresponded to the study by Andriani et al 11 which found that LPR patients were mostly found in female respondents as many as 62.75%, also study by Asyari et al 12 which found as many as 76.7%, and Sarkar et al 13 which found as many as 68.2%. This was caused by hormonal factors.…”

“…14 Hormonal factors also play a role in the increase of gastric acid secretion, where this factor directly stimulates parietal cells and peptic glands, hormonal pathway originates from the hypothalamus to the anterior pituitary gland and adreno-corticotropic hormone (ACTH) and stimulates the adrenal glands to produce cortisone and adrenaline which causes stimulation of parietal cells and peptic glands to produce HCl and pepsin. 11 Thus, LPR could occur or become aggravated during hormonal fluctuations in perimenopausal and menopausal periods. 14 Based on sex characteristics in this study, LTH was mostly found in females, as many as 19 respondents (63.33%) and in males as many as 7 respondents (23.33%).…”

The Profile of Laryngopharyngeal Reflux Patients at Dr. Soetomo Teaching Hospital, Surabaya Indonesia

“…8 Another study conducted by Andriani, et al, for 51 patients with LPR, there were female (62.75%) and male (37.25%) patients. 9 The youngest age of LPR patients who sought treatment was 20 years old, and the oldest was more than 71 years. The largest age group with LPR was 41 to 50 years old, with 11 patients (26.19%) (Table 1).…”

Effectivity of alkaline water on the clinical improvement in laryngopharyngeal reflux

“…The results of this study indicated that LPR cases were more frequently found in female subjects (83.3%) compared to male subjects (16.7%), with a ratio of 1.7:1. 9,10 The most frequent main complaint that brought subjects for treatment was throat clearing [11 patients (37%)]. Meanwhile, complaints of heartburn and difficulty in breathing were not the main complaints that brought subjects to come for treatment.…”