Pepsin in saliva as a diagnostic biomarker in laryngopharyngeal reflux: a meta-analysis

Wang, Jing; Zhao, Yu; Ren, Jianjun; Yang, Xu

doi:10.1007/s00405-017-4845-8

Cited by 63 publications

(67 citation statements)

References 23 publications

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“…With regard to the key role of pepsin in the development of the inflammatory reaction of the laryngopharyngeal mucosa, many authors presumed that saliva pepsin concentration was associated with number and/or duration of proximal reflux episodes . In this preliminary study, we did not identify significant association between RSS, key symptoms during the test period, MII‐pH findings, GI endoscopy characteristics, and pepsin concentrations in saliva samples.…”

Section: Discussioncontrasting

confidence: 70%

“…Peptest (RD Biomed) is a new promising diagnostic test, but result interpretation still is difficult. With sensitivity and specificity of 64% and 68%, respectively, and with regard to the lack of correlation with reflux episodes, this approach must not call into question the use of MII‐pH. Additionally, this preliminary report is raising many unresolved issues about the pathophysiological mechanisms of pepsin in the development of mucosal injury, the place of Peptest in the LPR management, and the result interpretation.…”

Section: Discussionmentioning

confidence: 95%

“…In that respect, some new noninvasive diagnostic approaches have been developed, such as pepsin detection in saliva samples (Peptest, RD Biomed, Milan, Italy) . This approach was developed according to some studies, which reported that the deposit of pepsin on the laryngopharyngeal mucosa leads to the development of mucosal inflammation and injury and the related symptoms and signs . Peptest (RD Biomed) provides a measurement of the pepsin saliva concentration, which theoretically is correlated with the occurrence of pharyngeal/proximal esophageal reflux episodes within the previous hours .…”

Section: Introductionmentioning

confidence: 99%

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Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Bobin¹,

Journé

Lechien

2019

The Laryngoscope

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Objective: To investigate the relationship between the laryngopharyngeal reflux (LPR) episodes at the multichannel intraluminal impedance-pH monitoring (MII-pH) and the concentration of pepsin in the saliva of LPR patients.Methods: Patients with LPR were enrolled from the polyclinic of Poitiers, France. Patients benefited from 24-hour MII-pH that allowed a correlation study between reflux episodes and symptoms. Patients reported the occurrence of the critical symptoms during the testing period through a recording device. Simultaneously, they collected a first saliva sample 30 minutes after the symptoms and a second saliva collection a few hours after the first collection. The patient symptoms were assessed with reflux symptom score (RSS). The relationship between pepsin concentration in the saliva, symptoms, and the reflux episode characteristics at the MII-pH was investigated through multiple linear regression.Results: A total of 65 patients with LPR were recruited. The mean concentrations of the first and the second pepsin samples were 92.0 AE 108.1 and 101.8 AE 131.0, respectively. Peptest (RD Biomed, Milan, Italy) was positive in 51 LPR patients (78.5%). Concentrations of both pepsin samples were significantly correlated (P = 0.019). There was no significant association between pepsin concentrations in saliva samples, RSS, key symptoms during the test period, and MII-pH findings.Conclusion: The level of pepsin saliva concentration is not associated with the reflux episodes at the MII-pH. Future studies are needed to better understand the relationship between the extracellular pepsin concentration, mucosal inflammation, and related laryngopharyngeal symptoms.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Bobin¹,

Journé

Lechien

2019

The Laryngoscope

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“…25 Salivary pepsin level can quickly distinguish true reflux with non-reflux diseases, and is important for the diagnosis of GERD patients with predominant respiratory symptoms. [14][15][16][17]26 In this study, the positive rate of detecting EES was 68.2%, which was consistent with the observation of a previous study, 24 suggesting that salivary pepsin is of certain diagnostic value for the diagnosis of EES. In addition, the salivary pepsin level and positive rate in the BE group were significantly higher than those in the HC group in the present study, suggesting that pepsin reflux does play a significant role in the process of BE formation.…”

Section: Discussionsupporting

confidence: 92%

“…13,14 This detected the presence of pepsin in the saliva, sputum, alveolar lavage fluid and middle ear effusion as a sign of previous reflux events providing a basis for the diagnosis of reflux diseases. [13][14][15][16] The Peptest kit, which contains 2 anti-human pepsin antibodies, using colloidal gold immunochromatography and antigenantibody reaction principles to specifically capture the pepsin in the sample without influence by the pepsin activity, can be used in rapid detection of salivary pepsin concentration (SPC) by using colloidal gold immunochromatography and highly specific antigen-antibody reaction. 13,17 Research on pepsin detection for the diagnosis of GERD and GERD-related disorder is a hot spot nowadays, [13][14][15][16][17] but rarely reported in China.…”

Section: Introductionmentioning

confidence: 99%

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Wang

Lang

et al. 2020

J Neurogastroenterol Motil

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Background/AimsTo determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. MethodsOverall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES). ResultsCompared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett's esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002). ConclusionsSalivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency. (J Neurogastroenterol Motil 2020;26:74-84)

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Pepsin exposure in a non‐acidic environment upregulates mucin 5AC (MUC5AC) expression via matrix metalloproteinase 9 (MMP9)/nuclear factor κB (NF‐κB) in human airway epithelial cells

Choi

Bae

et al. 2020

Int Forum Allergy Rhinol

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Background Gastric reflux GR is a backflow of gastric content to the aerodigestive tract GR was previously found to be associated with inflammatory airway diseases and a potential cause of airway remodeling Chronic exposure to gastric content may induce damage from nose to lung because digestive enzymes and acidity are toxic to airway epithelial cells Recently the toxicity of pepsin in a non-acidic environment was found to increase proinflammatory cytokines and receptors in the epithelium of the aerodigestive tract However the effect of pepsin in non-acidic conditions on mucin expression has not been investigated in human airway epithelial cells The purpose of this study was to evaluate the effect of pepsin on mucin AC MUC AC expression in upper and lower airway epithelial cells as an important potential factor of non-acidic GR-related airway inflammation Methods In NCI-H cells and human nasal epithelial cells HNEpCs the effects and signaling pathways of pepsin on MUC AC expression were examined using reverse-transcription polymerase chain reaction RT-PCR real-time PCR enzyme immunoassay zymography Western blot and immunofluorescence staining ResultsPepsin increased MUC AC expression in non-acidic condition of NCI-H cells and HNEpCs Further pepsin activated matrix metalloproteinase MMP and phosphorylated nuclear factor κB NF-κB Moreover inhibitors of MMP and NF-κB significantly attenuated pepsin-induced MUC AC expression and the knockdown of NF-κB by small interfering RNA siRNA significantly blocked pepsin-induced MUC AC expression in human airway epithelial cells Conclusion These findings suggest that pepsin increased MUC AC expression in non-acidic conditions via the activation of MMP and NF-κB in human airway epithelial cells

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Pepsin in saliva as a diagnostic biomarker in laryngopharyngeal reflux: a meta-analysis

Abstract: Pepsin in saliva has moderate value in the diagnosis of LPR. The cutoff value used could affect the diagnostic value. Therefore, further investigations are required to find the optimal method to detect salivary pepsin in diagnosing LPR.

Cited by 63 publications

References 23 publications

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Saliva pepsin level of laryngopharyngeal reflux patients is not correlated with reflux episodes

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Pepsin exposure in a non‐acidic environment upregulates mucin 5AC (MUC5AC) expression via matrix metalloproteinase 9 (MMP9)/nuclear factor κB (NF‐κB) in human airway epithelial cells

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