Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24‐hour esophageal impedance/pH monitoring in pediatric patients

Fortunato, John E.; D’Agostino, RB; Lively, Mark O.

doi:10.1111/nmo.12936

Cited by 46 publications

(52 citation statements)

References 47 publications

(133 reference statements)

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“…Potluri et al used the fibrinogen digestion method to compare saliva/sputum pepsin assay with 24‐hour esophageal pH monitoring, for detection of gastric reflux into the proximal esophagus, oropharynx, and lungs. Several different assays for detecting pepsin in saliva/sputum, including Western blot and enzyme‐linked immunosorbent assay, have been used in the lab. However, these methods are both laborious and time consuming.…”

Section: Discussionmentioning

confidence: 99%

“…A positive PPI response after treatment further confirmed the diagnosis of LPR in good responders. With regard to the collection of saliva/sputum samples, Fortunato el al . discovered that the concentration of salivary/sputum pepsin had covered a wide range when observed in individuals over 24 hours, and that saliva/sputum samples must be obtained soon after a reflux event.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

Wang

Lien²,

Lin

et al. 2018

The Laryngoscope

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Objectives/Hypothesis To evaluate the prediction value of saliva pepsin detection for an 8‐week proton pump inhibitor (PPI) response in patients with a Reflux Symptoms Index (RSI) score ≥13, which indicates possible laryngopharyngeal reflux. Study Design Prospective individual single‐cohort study. Methods Patients were recruited who had experienced chronic laryngopharyngeal symptoms (RSI score ≥13) for more than 3 months after excluding other etiologies. The patients received PPI (40 mg of esomeprazole once daily) treatment for 8 weeks. Prior to treatment, the patients submitted saliva/sputum samples that were collected during the time symptoms were observed. The samples were taken for pepsin detection, and performed using the commercially available Peptest lateral flow device. The association of the Peptest results and PPI response were statistically analyzed with the χ2 test. Results Seventy‐four patients completed the study, and upon completion of PPI treatment, the mean RSI score was significantly reduced from 19.22 ± 5.18 to 8.99 ± 5.69. Forty‐four (59.5%) patients exhibited a good response as defined by an RSI score reduction ≥50%. The results of the Peptest were semiquantitatively graded as 0, 1, 2, 3 (negative, weak positive, moderate positive and strong positive, respectively) based upon the visual intensity of the test sample line as compared to the control line. Twenty‐four patients (32.4%) exhibited grade 3 strong positive results. The Peptest strong positive results (P < .05) were significantly associated with a good PPI response, with the positive predictive value being 79.2%. Conclusions Analysis of strong positive results for pepsin detection in saliva/sputum samples may be a useful, noninvasive method for predicting better PPI response in patients with suspected reflux induced chronic laryngopharyngeal symptoms. Level of Evidence 2 Laryngoscope, 129:709–714, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

Wang

Lien²,

Lin

et al. 2018

The Laryngoscope

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“…Another limitation of our study may include our center's interpretation of pH‐MII studies. Several centers vary their positive criteria for reflux regarding number of events and symptom correlation due to a lack of standardized metrics in pediatrics . This study demonstrated that pH‐MII‐defined GERD diagnosis was higher, perhaps up to 2× the prevalence of the general population, but still overall relatively low regarding diagnostic yield.…”

Section: Discussionmentioning

confidence: 84%

“…This study demonstrated that pH‐MII‐defined GERD diagnosis was higher, perhaps up to 2× the prevalence of the general population, but still overall relatively low regarding diagnostic yield. If other published standards, such as 72 events were used, in this study for children >1 year of age, the diagnosis of GERD or excessive esophageal acid exposure using pH‐MII may have been lower . Finally, this study primarily looked at the reflux evaluation and not the other components of aerodigestive care.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

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Objective To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH‐MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results Mean patient age was 3.15 years (range 0.15‐24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH‐MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH‐MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH‐MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH‐MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

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“…The first insight that can be found in literature, concerning the possible involvement of ENT anatomical structures in the reflux pathology, goes back to 1903; in fact, Coffin speculated "gas reflux from the stomach" as well as the "hyper-acidity" could be considered responsible for hoarseness and back rhinorrhea [1][2][3][4]. Starting from the '80s, besides the relatively "old" knowledge of GED, a new concept arose; it proposed LPR could have been caused by "acid vapors" action, coming from the stomach.…”

Section: Introductionmentioning

confidence: 99%

Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptesttm

Gelardi¹,

Eplite²,

Mezzina³

et al. 2017

IJOAOT

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LaryngoPharyngeal Reflux (LPR) is a term recently described, classified among the "extra-esophageal disorders", caused by another pathology called "Gastro-Esophageal Disease" (GED). Pepsin has been recognized as the true marker and the responsible factor of mucosal damage.The clinical-instrumental diagnosis of LPR is mainly based upon video laryngoscopy exam, pH-measuring, pH-impedance measuring, using "score" questionnaires, designed to establish the presence of specific symptoms (Reflux Symptom Index -RSI) and endoscopic signs (Reflux Finding Score -RFS). The evidence of the role of pepsin associated to the LPR helped to develop new technologies, able to detect the presence of that enzyme within the saliva; this device is called Peptest TMThe aim of the present study was to correlate the qualitativequantitative values of salivary pepsin (using Peptest TM ) with symptoms and signs obtained from RSI and RFS. The final goal is to validate this enzyme immunoassay method using LPR diagnostic tools.Seventy-five patients were recruited (41 females, 34 males) aged between 12 and 71 years old, (average age 45 years). All patients performed anamnesis, including food habits analysis, RSI evaluation, rhinofibrolaryngoscopy exam with RFS calculation and Peptest TM.Highly comparable results were obtained in all of the 75 patients undergoing double detection of Peptest TM , with LFD measure (T band intensity) and pepsin concentration (ng/ml).Statistically significant correlation concerning symptoms and saliva pepsin concentration was demonstrated as well as the relationship between objective signs and saliva pepsin concentration. The PeptestTM could become the "Gold standard" in all cases LPR pathology suspicion and may allow revealing the symptoms of that pathology at its early onset, avoiding dealing with more invasive methods and helping to adopt the correct therapeutic follow-up as soon as possible.

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Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24‐hour esophageal impedance/pH monitoring in pediatric patients

Abstract: NCT01091805.

Cited by 46 publications

References 47 publications

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptesttm

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