Gastric pepsin in middle ear fluid of children with otitis media: Clinical implications

Abstract

Gastroesophageal reflux and extraesophageal reflux have been postulated to be involved in the pathogenesis of otitis media. This is supported by recent studies revealing the presence of gastric pepsin in the middle ear space of children with otitis media but not in control patients without otitis media. Reflux's role in otitis media appears to be most pronounced in younger children and those with purulent effusions.

Role of pepsin and pepsinogen: Linking laryngopharyngeal reflux with otitis media with effusion in children

“…19 Meanwhile, O'Reilly et al concluded that recovery of pepsin in the middle ear space of pediatric patients with otitis media (OM) is an independent risk factor, and gastroesophageal reflux and extraesophageal reflux had been postulated to be involved in the pathogenesis of OM. [20][21][22] Their results, which indicated that adenoid tissues from the OME group had significantly higher pepsinogen immunoreactivity compared with those from the control group without OME, are suggestive of the involvement of LPR in OME. However, the study did not address whether there is physiologic reflux of pepsinogen that reaches the middle ear through the nasopharynx and eustachian tube in normal children, or whether there is physiologic accumulation of pepsinogen in the sera of normal children.…”

“…Recently, Al‐Saab et al provided the first line of evidence linking LPR to OME, by detecting pepsinogen in adenoid tissue and middle ear fluid . Meanwhile, O'Reilly et al concluded that recovery of pepsin in the middle ear space of pediatric patients with otitis media (OM) is an independent risk factor, and gastroesophageal reflux and extraesophageal reflux had been postulated to be involved in the pathogenesis of OM . Their results, which indicated that adenoid tissues from the OME group had significantly higher pepsinogen immunoreactivity compared with those from the control group without OME, are suggestive of the involvement of LPR in OME.…”

The association of premorbid diseases with chronic rhinosinusitis with and without polyps

“…(44) The proposed pathophysiology involved with these associations centers around the retrograde flow of gastric contents or its aerosolized form into various sites in the airway, resulting in direct mucosal injury with subsequent inflammation. In the GHS study, pre-morbid GERD showed modest but highly significant associations with both forms of CRS (Table 2).…”

“…Despite the established association between GERD and CRS (42–44), current literature lacks evidence to support direct causation. Only the GHS study looked at the temporal relationship between GERD and asthma.…”

Pepsinogen Assay as a Marker of Reflux in Children with Otitis Media with Effusion

“…Although most episodes resolve spontaneously, 5 to 10% of cases will persist for over 1 year [1]. The role of gastro esophageal reflux (GER) or extra esophageal reflux in this disease has only been recognized recently as one of the risk factors for OME in children [2]. GER disease (GERD) occurs when gastric contents reflux into the esophagus or oropharynx and produce symptoms.…”