Investigation of pepsin in tears of children with laryngopharyngeal reflux disease

Iannella, Giannicola; Nardo, Giovanni Di; Plateroti, Rocco; Rossi, Paolo; Plateroti, Andrea Maria; Mariani, Paola; Magliulo, Giuseppe

doi:10.1016/j.ijporl.2015.10.034

Cited by 45 publications

(39 citation statements)

References 31 publications

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“…Our finding is that pepsin is present in control, asymptomatic subjects and at measurable levels and does not have discriminatory potential for separating GERD from controls. This finding is consistent with other reports which found no difference between cases and controls, or found controls had higher levels . A recently published study concluded a value for Peptest in predicting GERD; however, there was no difference between controls and GERD patients when all sampling was taking into account, suggesting low reproducibility .…”

Section: Discussionsupporting

confidence: 92%

Studies of salivary pepsin in patients with gastro‐oesophageal reflux disease

Race

Chowdry

Russell

et al. 2019

Aliment Pharmacol Ther

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Background: Gastro-oesophageal reflux disease (GERD) is difficult to diagnose without invasive testing. Peptest (RD Biomed, Hull, UK) is a recently marketed diagnostic tool which aims to quantify salivary pepsin as a marker of reflux, providing a rapid alternative to invasive procedures. Aim:To evaluate optimal timing for sampling, and to evaluate the accuracy of Peptest against an independent measure. Methods: Thirty diagnosed GERD patients (12 female, mean age 49 [range 20-72])and 20 asymptomatic subjects (14 female, mean age 56 [range 21-56]) were subject to diurnal saliva sampling, with additional samples for 60 minutes following self-reported reflux symptoms and triggering of a proximal reflux alarm. Saliva samples were split and were analysed by both Peptest and ELISA with operators for each blinded to sample identity.Results: Salivary pepsin was detectable in most patients and most volunteers. Peptest scores were significantly lower for patients than controls (P < 0.005). ELISA scores showed no difference between patients and controls. There was no effect of diurnal sampling time (P = 0.75) or time after symptoms (P = 0.76) on Peptest readout. There was no correlation between Peptest and Pepsin ELISA (P = 0.55);Bland-Altman analysis suggested no agreement between the tests (P = 0.414).Receiver-operator curve suggests that neither Peptest (P = 0.3328) nor pepsin (P = 0.4476) is useful for predicting GERD.Conclusion: Salivary pepsin is not a reliable tool for the diagnosis of GERD.Caroline Race and Joanna Chowdry made an equal contribution to this work. Bernard M. Corfe and Stuart A. Riley made an equal contribution to this work.

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Section: Discussionsupporting

confidence: 92%

Studies of salivary pepsin in patients with gastro‐oesophageal reflux disease

Race

Chowdry

Russell

et al. 2019

Aliment Pharmacol Ther

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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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“…The gold standard for demonstrating reflux events are multi-channel intraluminal impedance (MCII) and pH monitoring studies [21,22,23]. Unfortunately, these tests are expensive, not easily applicable, and are often either not accepted or tolerated by patients [23,24,25]. Therefore, in clinical practice, a diagnosis based on endoscopic findings and clinical questionnaires is usually preferred [9,11,20,23,24,25].…”

Section: Introductionmentioning

confidence: 99%

Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test

Iannella

Vicini

Polimeni

et al. 2019

IJERPH

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Background: To investigate the presence of laryngopharyngeal reflux in patients with obstructive sleep apnea (OSA) employing the salivary pepsin concentration method. To compare the results of pepsin concentration with the severity of the pathology. Methods: Seventy-five OSA patients (44 males, 31 females) were enrolled in the study. For each patient, the AHI (apnea–hypopnea index) and the BMI (body mass index) were initially evaluated. All the patients enrolled were assessed using the reflux symptom index (RSI) and the reflux finding score (RFS) in order to perform a clinical diagnosis of laryngopharyngeal reflux. In all patients a salivary sample was taken to estimate the presence of pepsin and its concentration. Results: The incidence of LPR (laryngopharyngeal reflux) in OSA patients, evaluated using the salivary pepsin concentration test (PEP-test), was found to be 32% of cases. Linear regression testing did not show any correlation between AHI and pepsin concentration in salivary samples (p = 0.1). Conclusion: A high number of patients with OSA seem to show positivity for salivary pepsin, correlated to an LPR. There does not appear to be a correlation between the severity of apnea and the grade of salivary pepsin reflux. On the other hand, direct correlation between BMI and the value of pepsin in salivary specimens was observed.

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Investigation of pepsin in tears of children with laryngopharyngeal reflux disease

Abstract: 20% of the children with diagnosed LPR showed pepsin in the tears. Our specific investigation might provide information regarding sinusitis or dacryostenosis.

Cited by 45 publications

References 31 publications

Studies of salivary pepsin in patients with gastro‐oesophageal reflux disease

Studies of salivary pepsin in patients with gastro‐oesophageal reflux disease

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

Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test

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