Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux

Abstract

Objective To investigate the optimal time point for diagnosing laryngopharyngeal reflux (LPR) through combining 24‐h hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH (24‐h HEMII‐pH) monitoring and the multi‐time point salivary pepsin test (MTPSPT). Study Design Prospective uncontrolled trial. Method Patients with and without LPR symptoms were included as the test group and the control group, respectively. The patients in the test group underwent 24‐h HEMII‐pH and MTPSPT. The results of 24‐h HEMII‐pH were used as a diagnostic criterion for LPR, and the diagnostic value of salivary pepsin tests performed at different time points was compared by receiver operating characteristic (ROC) analysis. Results A total of 153 patients were included. Based on 24‐h HEMII‐pH, the positive rate of LPR in the test group of patients was 84.00%. In the control group, only one person (3.57%) had a positive salivary pepsin test result. The area under the curve (AUC) of the MTPSPT was 0.827. In addition, we separately calculated the AUC of the combined salivary pepsin test at different time points, and found good diagnostic value (AUC = 0.799) when the test was combined with the waking, 1 and 2 h after breakfast and lunch, and 1 h after dinner tests. However, when the number of tests were further increased, the diagnostic value did not improve significantly. Conclusion Salivary pepsin testing combined with waking, 1 h and 2 h after breakfast and lunch, and 1 h after dinner has almost the same diagnostic value as MTPSPT, and testing at these time points can be an effective method for diagnosing LPR. Level of Evidence 3 Laryngoscope, 133:1706–1711, 2023

The clinical application value of salivary pepsin in the diagnosis of gastroesophageal reflux diseases

“…Currently, the common clinical sampling times of Peptest include fasting in the morning, 1 h after meals, and within 10 min after symptom. Zhang et al found that the diagnostic value of fasting and postprandial Peptest was the same 15 . However, Hayat et al found that the diagnostic accuracy of postprandial Peptest were significantly higher than fasting 12 .…”

“…Zhang et al found that the diagnostic value of fasting and postprandial Peptest was the same. 15 However, Hayat et al found that the diagnostic accuracy of postprandial Peptest were significantly higher than fasting. 12 The positive rate of post-symptom Peptest were higher than postprandial Peptest.…”

Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux

“…The 24‐hour multichannel hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring (24 h HEMII‐pH) is considered to be the most accurate tool for diagnosing LPR, providing an objective picture of the occurrence of various types of LPR episodes. However, the 24 h HEMII‐pH is invasive, expensive, and not widely applied 3 . The clinical symptoms of LPR are not specific, but a composite LPR‐related symptom questionnaire can assist in screening of LPR.…”

“…However, the 24 h HEMII-pH is invasive, expensive, and not widely applied. 3 The clinical symptoms of LPR are not specific, but a composite LPR-related symptom questionnaire can assist in screening of LPR. As the easiest and quickest method, the symptom questionnaire is a screening tool that should not be overlooked in clinical practice.…”