Pepsin Detection in the Sputum/Saliva for the Diagnosis of Gastroesophageal Reflux Disease in Patients with Clinically Suspected Atypical Gastroesophageal Reflux Disease Symptoms

Abstract

Background/Aims: Atypical manifestations of gastroesophageal reflux disease (GERD) are diverse. We aimed to determine whether pepsin detection in the sputum/saliva could be useful for diagnosing GERD in patients with clinically suspected atypical GERD symptoms. Methods: Patients with clinically suspected atypical GERD symptoms provided sputum/saliva collected before bedtime, at the time of those symptoms, and after awakening for pepsin measurement by Western blot analysis. All subjects received 24-hour esophageal pH monitoring, and then 40 mg of esomeprazole was given twice a day for 2 weeks. Results: The pepsin test was positive in 20 out of 40 patients, with pepsin detected mainly in the samples collected at the time of symptoms (45%). Samples collected from healthy volunteers (n = 8) were all negative for pepsin. 24-hour pH-metry was positive in 9 patients (23%). Based on 24-hour pH-metry data, the sensitivity and negative predictive value of the pepsin test were excellent in most of typical and atypical symptom groups, whereas its specificity and positive predictive value were relatively low, particularly in atypical symptom groups. Conclusions: Pepsin measurement in the sputum/saliva collected at the time of symptoms provides a sensitive, non-invasive method for diagnosing GERD in patients with clinically suspected atypical GERD symptoms.

Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux

“…An immunoserologic test was used similar to the latter study. Another study reports a sensitivity of 89% and a specificity of 68% in a salivary pepsin western blot analysis (26). Other relevant studies also recommend pepsin as a diagnostic marker (27,28).…”

Demographic, Clinical, and Psychological Characteristics of the Heartburn Groups Classified Using the Rome III Criteria and Factors Associated with the Responsiveness to Proton Pump Inhibitors in the Gastroesophageal Reflux Disease Group

“…Although 24-hour esophageal pH monitoring has been regarded as the gold standard test for diagnosing GERD, it may not be sensitive because of day-to-day variability in symptom occurrence, inability to do normal activities due to an inserted nasal catheter, no detection of gastric contents aspirated into the lung and oropharynx, and no measurement of non-acid reflux. Actually, it has recently been shown that 24-hour pH-metry results are not well correlated with PPI test results, particularly in patients suspected to have atypical GERD symptoms [18]. Evaluation by impedance pH monitoring or 48- or 72-hour catheterless pH monitoring might compensate for these drawbacks.…”

Pepsin measured in induced sputum—a test for pulmonary aspiration in children?

“…Indeed, studies in adults have correlated 24-hour pH monitoring results with the detection of pepsin in saliva or sputum, the authors concluding that pepsin detection was indicative of proximal GER [15,16]. Furthermore, Little et al [17] stated that any reflux to the hypopharynx was significant in patients with respiratory symptoms.…”