Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux

Abstract

Background: The PeptestTM is a non-invasive diagnostic test for measuring the pepsin concentration in saliva, which is thought to correlate with laryngopharyngeal reflux (LPR). The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR. Methods: Patients with suspected LPR were examined with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), fasting Peptest, and MII-pH monitoring. We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Peptest, RSI, and RFS based on the threshold of one and six hypopharyngeal reflux episodes. Results: Altogether, the data from 46 patients were analyzed. When one hypopharyngeal reflux episode was used as a diagnostic threshold for LPR, the accuracy, sensitivity, specificity, PPV, and NPV were, respectively, as follows: 35%, 33%, 100%, 100%, and 3%, for the Peptest; 39%, 40%, 0%, 95%, and 0%, for the RSI; and 57%, 58%, 0%, 96%, and 0%, for the RFS. The accuracy, sensitivity, specificity, PPV, and NPV of the Peptest for diagnosing gastroesophageal reflux disease (GERD) were 46%, 27%, 63%, 40.0%, and 48%, respectively. Conclusions: A positive Peptest is highly supportive of a pathological LPR diagnosis. However, a negative test could not exclude LPR.

Development of Highly Sensitive Fluorescent Sensors for Separation-Free Detection and Quantitation Systems of Pepsin Enzyme Applying a Structure-Guided Approach

“…In our study, we have achieved an LOD of 0.12 µmol L −1 for pepsin using our novel fluorescent RMIPs. While direct comparison with Peptest™ in terms of concentration units may not be straightforward due to differences in assay methodologies, our MIP-based approach offers a comparable sensitivity to conventional diagnostic tests for pepsin detection [ 25 ]. Furthermore, our MIPs offer several advantages over traditional methods, including enhanced selectivity, ease of use, and potential for integration into point-of-care diagnostic devices.…”

“…As a result, elevated levels of pepsin in the saliva of patients could be used as a biomarker for GERD and act as an early, simple, and non-invasive diagnostic tool [ 24 ]. Up till now, the main method of measuring the level of pepsin and diagnosis of GERD is the Peptest ® , which is an ELISA method utilising antibodies [ 25 ]. However, we aim to find a synthetic, cheaper, and more stable alternative to conventional antibody testing.…”

Review article: Diagnosis and management of laryngopharyngeal reflux

“…Most studies, but not all, utilised 24 h impedance-pH testing, and it is unclear if all studies were conducted in the fasting state. 79 When evaluating LPR, Zeleník et al 80 66 Bile acids are thought to exert their negative effects in several ways. At a pH of ≤4, conjugated bile acids tend to be unionised increasing their propensity to penetrate the cell membrane and inflict damage.…”

“…When evaluating LPR, Zeleník et al 80 utilised Peptest for fasting morning pepsin detection and based on 24 h impedance‐pH monitoring found the sensitivity and specificity, based on six hypopharyngeal reflux episodes, were 37% and 82%, respectively, and based on DeMeester score were 27% and 63% respectively. Wang et al.…”

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

“…Pepsin saliva detection (Peptest ® ; RD Biomed Ltd., Hull, UK) is another diagnostic method that was investigated in the past decade [ 81 , 82 ]. Pepsin is involved in the development of mucosal inflammatory reaction, and injuries and may be detected in saliva of LPR patients [ 1 ].…”