Does Pepsin Play a Role in Etiology of Laryngeal Nodules?

Taşlı, Hamdi; Eser, Burcu; Aşık, Mehmet Burak; Bırkent, Hakan

doi:10.1016/j.jvoice.2018.04.009

Cited by 6 publications

(13 citation statements)

References 14 publications

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“…One study stated that nodules and LPR‐related symptoms were more prevalent in elderly patients than younger subjects . Recently, Tasli et al evaluated pepsin levels in vocal fold nodule specimens that were removed in patients with long‐term history of dysphonia; using Western blot and enzyme‐linked immunosorbent assay analyses, these authors did not identify pepsin in operated nodule specimens . Another article reported that patients with LPR symptoms have poorer response to vocal fold steroid injection for nodule treatment .…”

Section: Resultsmentioning

confidence: 99%

“…Counting articles across several categories when appropriate, 32 of these articles are related to nodules, 29 to polyps, 18 to cysts, 32 to Reinke's edema, and 10 to sulcus vocalis. When filtered through the inclusion and exclusion criteria, a total of 35 articles were kept for analysis: 16 are related to nodules, 5,7,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] eight to polyps, 7,20,[22][23][24]26,31,32 three to cysts, 18,20,30 five to Reinke's edema, 22,24,26,33,34 and three to sulcus vocalis 7,18,35 (Fig. 1).…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…19 Recently, Tasli et al evaluated pepsin levels in vocal fold nodule specimens that were removed in patients with longterm history of dysphonia; using Western blot and enzymelinked immunosorbent assay analyses, these authors did not identify pepsin in operated nodule specimens. 17 Another article reported that patients with LPR symptoms have poorer response to vocal fold steroid injection for nodule treatment. 20 As shown in our bias analysis, none of the studies in this paragraph used pH monitoring to confirm LPR diagnosis (Table I).…”

Section: Laryngopharyngeal Reflux and Nodulesmentioning

confidence: 99%

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Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

et al. 2019

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Objectives To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). Methods PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria. Results Of the 155 relevant publications, 42 studies were included. Thirty‐five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell‐to‐cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. Conclusions Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high‐quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329–E341, 2019

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Laryngopharyngeal Reflux and Nodulesmentioning

confidence: 99%

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Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

et al. 2019

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“…35 Tasli et al reported that Western blot and enzyme-linked immunosorbent assay analyses did not detect pepsin in tissue specimens from 28 patients with vocal cord nodules. 26 However, Lechien et al noted that the diagnostic criteria used by Tasli et al may have been biased with regard to the selection of patients with LPR. 34 Moreover, Lechien et al argued that the lack of pepsin expression did not exclude the involvement of LPR from vocal cord nodules because pepsin is expressed in laryngeal epithelial tissue (eg, vocal cord epithelium and pharyngeal mucosa) rather than in the fibrous tissue of vocal cord nodules.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24][25] Whether pepsin contributes to the development of laryngeal precancerous lesions is unclear, although a few studies have investigated the role of pepsin in laryngeal benign lesions. 7,25,26 They showed that the malignant transformation rate increases with the increasing grade of dysplasia in vocal cord leukoplakia. However, the relationship between the expression of pepsin and the grade of dysplasia in leukoplakia has not been investigated.…”

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confidence: 99%

Relationship Between Pepsin Expression and Dysplasia Grade in Patients With Vocal Cord Leukoplakia

Chen

Bao

Zhou

et al. 2020

Otolaryngol.--head neck surg.

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Objective To measure pepsin expression in patients with vocal fold leukoplakia and elucidate its clinical significance. Study Design Retrospective analysis of pathologic archive specimens. Setting Affiliated university hospital. Subjects and Methods The study included 45 patients with vocal fold leukoplakia and 19 with vocal fold polyps who underwent surgical treatment between December 2013 and July 2016. Masses were detected on both vocal cords in 5 patients with vocal fold leukoplakia and in 1 patient with vocal fold polyps. Immunohistochemistry was used to assess pepsin expression. In addition, the relationship of pepsin expression level with clinical characteristics of vocal fold leukoplakia was assessed. Results The rate of pepsin expression was high in the polyp group (75%) and the leukoplakia group (68%); however, the difference between groups was not significant ( P > .05). Pepsin expression significantly increased according to grade of dysplasia (mild, 57.1%; moderate, 88.9%; severe, 100.0%; P = .034). Similarly, the percentage of lesions that exhibited strongly positive pepsin expression increased with the grade of dysplasia (mild, 37.1%; moderate, 66.7%; severe, 100.0%; P = .005). The leukoplakia recurrence rate was higher in patients with positive pepsin expression than in patients with negative pepsin expression but without a significant difference ( P > .05). Conclusion Our study suggests that pepsin was associated with the grade of dysplasia of vocal cord leukoplakia. Further investigation with appropriate control groups and controlling for other risk factors, such as smoking or alcohol consumption, is needed.

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Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta‐analysis

Ren,

Lei,

Zhao

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThere is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta‐analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs.Data SourcesRelevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science.Review MethodsWe evaluated between‐study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random‐effects models were used when significant heterogeneity was observed; otherwise, fixed‐effects models were used.ResultsThirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84‐5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I2 = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double‐probe or 3‐site pH monitoring, and with 24‐hour multichannel intraluminal impedance‐pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke's edema, nodules, and polyps (P for subgroup difference = .09).ConclusionPharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.

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Does Pepsin Play a Role in Etiology of Laryngeal Nodules?

Cited by 6 publications

References 14 publications

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

Relationship Between Pepsin Expression and Dysplasia Grade in Patients With Vocal Cord Leukoplakia

Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta‐analysis

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