Optimal timing of saliva collection to detect pepsin in patients with laryngopharyngeal reflux

Na, Se Young; Kwon, Ohseong; Lee, Young Chan; Eun, Young‐Gyu

doi:10.1002/lary.26018

Cited by 75 publications

(86 citation statements)

References 26 publications

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“…Indeed, a sensitive immunoassay for pepsin previously demonstrated up to 100% sensitivity and 89% specificity for reflux as identified by pH monitoring . Since the introduction of MII‐pH monitoring, more recent work has identified the presence of pepsin in the saliva of many patients with impedance‐confirmed proximal reflux, suggesting a potential role for pepsin in the diagnosis of LPR . Proximal reflux is also suggested as a contributor to rhinologic disease such as chronic rhinosinusitis (CRS), a notion bolstered by literature identifying a high prevalence of reflux in patients with poor outcomes following endoscopic sinus surgery for CRS .…”

Section: Introductionsupporting

confidence: 89%

“…In a study of gastroesophageal reflux disease (GERD) patients, Hayat et al demonstrated that salivary pepsin was significantly more likely to be detected in specimens collected in the postprandial period . More recently, however, Na et al studied a population of patients with proximal reflux confirmed with MII‐pH monitoring and found that salivary pepsin levels were significantly higher upon awakening than after meals or when symptoms occurred . Therefore, the optimal timing for collection of salivary pepsin for the purpose of diagnosing EER remains uncertain.…”

Section: Introductionsupporting

confidence: 59%

“…Therefore, the optimal timing for collection of salivary pepsin for the purpose of diagnosing EER remains uncertain. Further, in the aforementioned studies, healthy controls exhibited positive salivary pepsin . The utility of salivary pepsin in establishing a diagnosis of LPR is therefore unclear.…”

Section: Introductionsupporting

confidence: 59%

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Correlation of salivary and nasal lavage pepsin with MII‐pH testing

et al. 2019

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Objectives Laryngopharyngeal reflux (LPR) is a common upper airway disease. Salivary pepsin is a proposed marker for LPR; however, the optimal time for collection of specimens for pepsin detection and pepsin's presence in the oral and nasal secretions relative to concurrent multichannel intraluminal impedance‐pH (MII‐pH) monitoring are unknown. Study Design Prospective case‐control study with an experimental design. Methods Patients undergoing MII‐pH testing for evaluation of LPR and asymptomatic control subjects were selected. Nasal lavage and saliva samples were collected in the clinic prior to MII‐pH probe placement. Additional saliva samples were obtained an hour after each meal and upon waking the following morning. Nasal lavage and salivary pepsin were measured by ELISA. Results Twenty‐six patients undergoing MII‐pH testing and 13 reflux‐free control patients were enrolled. Salivary pepsin was detected in 11 of 26 patients with suspected LPR and 0 of 13 controls. Pepsin was most frequently detected in the specimen provided upon waking at an average concentration of 186.9 ng/mL. A significant correlation was observed between salivary pepsin in waking samples to MII‐pH measurements, including reflux bolus duration, and proximal and distal recumbent reflux episodes (P < 0.05). A significant correlation was also observed between salivary pepsin upon waking or sinus lavage and reflux symptom index (P < 0.05). Conclusion Pepsin in salivary and nasal lavage samples demonstrated an association with MII‐pH‐documented LPR. Pepsin detection was most frequent in morning samples, supporting use of morning salivary pepsin levels as a potential noninvasive technique for LPR diagnosis. Level of Evidence 2 Laryngoscope, 130:961–966, 2020

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Section: Introductionsupporting

confidence: 89%

Section: Introductionsupporting

confidence: 59%

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Correlation of salivary and nasal lavage pepsin with MII‐pH testing

et al. 2019

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“…The higher prevalence of salivary pepsin in the latter adult studies compared with ours may have been because their saliva sampling was timed with symptoms. In a study by Na et al, salivary pepsin concentrations were highest after an overnight fast, before any meals were ingested and without any associated symptoms 33 . In our study, all patients had salivary samples obtained after a 2 hour minimum NPO period.…”

Section: Discussionmentioning

confidence: 93%

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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“…Pepsins are major proteolytic enzymes present in the gastric juices produced by the gastric chief cells and hence can only occur in saliva as a result of gastric contents reaching the oral cavity [21]. It appears that gastro-oesophageal reflux disease patients have higher [pepsin] saliva than healthy individuals, possibly due to more frequent or larger volumes of refluxate reaching the oral cavity in the disease condition [22,23]. Pepsin therefore seems an ideal, acute biomarker of reflux events and the authors hypothesise that higher concentrations of pepsin will be found in saliva if the intake of carbonated beverages or other "refluxogenic" food items has caused the gastric contents to reach the oral cavity.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Acute Effects of Carbonated Beverage Consumption on Symptoms and Objective Markers of Gastric Reflux

Lim

2018

Gastrointestinal Disorders

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Previous studies have suggested that carbonated beverages may cause gastro-oesophageal reflux. Pepsin (the major enzyme secreted by the stomach) has been suggested to be an objective, acute marker of a reflux event. This pilot study aimed to investigate whether intake of carbonated beverages could affect pepsin concentration in saliva or reflux symptoms. This was assessed by a randomised, crossover trial where participants consumed 330 mL of beverage (carbonated cola, degassed cola or water) at separate visits. Saliva samples and symptom questionnaires were collected at baseline and over the 30 min postprandial period. Pepsin was detected in all saliva samples. No difference was found in the salivary pepsin concentrations between treatments at all time points. There were significantly higher scores (p > 0.05) for feelings of fullness, heartburn, urge to belch and frequency of belches after ingestion of carbonated cola than degassed cola and water. The ingestion of carbonated beverages did not appear to increase postprandial pepsin concentration in saliva compared to other beverages but did evoke higher levels of reflux-related symptoms such as fullness, heartburn and belching. This suggests carbonated beverages may cause symptoms associated with reflux but do not drive detectable levels of gastric juice to reach the oral cavity.

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Optimal timing of saliva collection to detect pepsin in patients with laryngopharyngeal reflux

Abstract: 3b Laryngoscope, 126:2770-2773, 2016.

Cited by 75 publications

References 26 publications

Correlation of salivary and nasal lavage pepsin with MII‐pH testing

Correlation of salivary and nasal lavage pepsin with MII‐pH testing

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

Assessment of the Acute Effects of Carbonated Beverage Consumption on Symptoms and Objective Markers of Gastric Reflux

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