Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest

Formánek, Martin; Zeleník, Karol; Komínek, Pavel; Matoušek, Petr

doi:10.1016/j.ijporl.2015.02.013

Cited by 27 publications

(32 citation statements)

References 24 publications

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“…In conclusion, salivary pepsin detection using an immunoassay has been proposed as a rapid, convenient, noninvasive, and easily-interpretable means of diagnosing GER – particularly as it relates to extraesophageal symptoms 8,16,34,35 . However, based on this study, single-point-in-time salivary pepsin does not appear to correlate well with pathologic reflux by pH-MII testing in children.…”

Section: Discussionmentioning

confidence: 99%

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease

Amirault

Mitchell

et al. 2016

The Journal of Pediatrics

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Objectives To determine the sensitivity of salivary pepsin compared with multichannel intraluminal impedance with pH testing (pH-MII), endoscopy, and gastroesophageal reflux disease (GERD) questionnaires. Study design We prospectively recruited 50 children from Boston Children’s Hospital, who were undergoing pH-MII to evaluate for GERD. Patients completed 24 hour pH-MII testing, symptom and quality of life questionnaires, and provided a saliva specimen which was analyzed using the PepTest® lateral flow test. A subset of patients also underwent bronchoscopy and esophagogastroduodenoscopy. ROC analyses were performed to determine the sensitivity of salivary pepsin compared with each reference standard. Results 21 patients (42%) were salivary pepsin positive, with median concentration of pepsin in the saliva 10 ng/mL (IQR 10 – 55). There was no significant difference in the distributions of acid, nonacid, total reflux episodes, full column reflux or any other reflux variable in patients that were pepsin positive compared with pepsin negative (p>0.5). There was no significant correlation between the number of reflux episodes and pepsin concentrations (p>0.1). There was no positive relationship between salivary pepsin positivity, any extraesophageal symptoms or quality of life scores, or inflammation on bronchoscopy or esophagogastroduodenoscopy (p>0.3). Conclusions Salivary pepsin measurement has a low sensitivity for predicting pathologic gastroesophageal reflux in children.

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Section: Discussionmentioning

confidence: 99%

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease

Amirault

Mitchell

et al. 2016

The Journal of Pediatrics

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“…The LPR is involved in the development of many otolaryngological diseases through the deposit of gastroduodenal enzymes into the mucosa of the upper aerodigestive tract. Thus, pepsin has been identified in the laryngeal [5], hypopharyngeal [6], oral [7], nasal [7], tears [8], and Eustachian mucosa as well as in the secretion of chronic rhinosinusites [9] and chronic media otitis [10]. The involvement of reflux in the development of dental disorders has been suspected for several decades.…”

Section: Introductionmentioning

confidence: 99%

Laryngopharyngeal reflux, gastroesophageal reflux and dental disorders: A systematic review

Lechien¹,

Chiesa‐Estomba

Henriquez³

et al. 2020

PLoS ONE

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Objectives To investigate the role of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in the development of dental disorders. Methods The first outcome was review of the role of reflux in the development of dental disorders in adults. The second outcome was review of the potential pathophysiological mechanisms underlying the association between reflux and dental disorders. Three investigators screened publications for eligibility and exclusion based on predetermined criteria through a literature search conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results From 386 publications, 24 studies were kept for analysis. Objective approaches were used in 16 studies to confirm GERD diagnosis. Pharyngeal reflux episodes (LPR) were considered in 2 studies. No study considered nonacid reflux. The study results supported a higher prevalence of dental erosion and caries in reflux patients compared with healthy individuals.

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“…In the physiological condition, pepsin is detectable only in the stomach, while in patients with LPR, the presence of pepsin was demonstrated also in the salivary fluid, and salivary pepsin dosage was proposed as a biomarker for LPR diagnosis [ 11 , 12 ]. In addition, it has been shown that pepsin can reach other nasopharyngeal-related structures during reflux episodes, such as the middle ear in patients with otitis media or nasal cavity of patients with chronic rhinosinusitis [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Pepsin has been detected also in the tear film of patients with gastroesophageal reflux (GER) and in children with LPR [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux

Plateroti

Sacchetti

Magliulo

et al. 2020

Life

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Background: patients with laryngopharyngeal reflux (LPR) showed detectable levels of tear pepsin that explain the nasolacrimal obstruction. The purpose of this study was to determine whether patients with LPR show ocular surface changes and to investigate the relationship between lacrimal pepsin concentration and ocular alterations. Methods: Fifty patients with positive endoscopic signs for LPR and an equal or higher score of 13 and 7 for Reflux Symptom Index and Reflux Finding Score were enrolled. Twenty healthy patients with no reflux disease and dry eye were included as the control group. After evaluation of ocular discomfort symptoms, the tear break-up time test, corneal staining, and tear sampling were performed. Tear pepsin levels were measured using Pep-testTM kit. Results: Patients with LPR showed ocular surface changes including epithelial damage (48%) and impairment of lacrimal function (72%). Tear pepsin levels were detectable in 32 out of 50 (64%) patients with LPR (mean ± SD: 55.4 ± 67.5 ng/mL) and in none of the control subjects. Most of the LPR patients complained of ocular discomfort symptoms, including itching (38%), redness (56%), or foreign body sensation (40%). Tear pepsin levels were significantly correlated with the severity of LPR disease and with ocular surface changes. Conclusions: A multidisciplinary approach, including ophthalmological evaluation, should be considered in order to improve the management of patients with LPR.

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Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest

Cited by 27 publications

References 24 publications

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease

Laryngopharyngeal reflux, gastroesophageal reflux and dental disorders: A systematic review

Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux

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