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

Abstract

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

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

“…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.…”

“…41,46 The current basic principle of drug therapy against GERD is to reduce gastric acid secretion and indirectly reduce the production of pepsin, thereby reducing the amount of gastric acid and pepsin refluxed to the esophagus, throat and other parts, resulting in significantly reduced clinical symptoms and the mucosa damages to the reflux site in GERD patients. 6,14,15 This study showed that for NERD patients, the positive rate of salivary pepsin test was significantly higher than the pathologic reflux as determined by 24-hour pH monitoring (71.9% vs 43.8%), suggesting that salivary pepsin test can complement or combine with the 24-hour pH monitoring and improve the efficiency in the diagnosis of GERD. A recent study showed that 24-hour pH monitoring was less sensitive in the diagnosis of NERD, 47 which was consistent with our study.…”

“…Therefore, GERD can be predicted by the change of pepsin concentration in saliva, and thus saliva pepsin may play an important role in the diagnosis of GERD. 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.…”

“…13,14 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.…”

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

“…Acidic event consisted of a gaseous or liquid reflux with a pH ≤ 4.0, whereas nonacidic event was a gaseous or liquid reflux with a pH >4.0. According to a recent study that defined normative data of MII‐pH in LPR, the LPR diagnosis was based on the occurrence of ≥ one proximal episode . GERD was defined as a length of time >4.0% of the 24‐hour recording spent below pH 4.0 or a DeMeester score >14.72.…”