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

Bobin, François; Journé, Fabrice; Lechien, Jérôme R.

doi:10.1002/lary.28260

Cited by 28 publications

(30 citation statements)

References 19 publications

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“…The last finding of this study is the lack of significant positive association between the occurrence of HREs and the saliva pepsin concentration. These results are not surprising, as a previous study reported no significant associations between saliva pepsin concentration and the HREs preceding the saliva samples 12 . Through more precise and detailed analyses, the findings of the present study may suggest that the measured saliva pepsin concentration does not reflect the quantity of deposited pepsin in the upper aerodigestive tract mucosa.…”

Section: Discussionsupporting

confidence: 48%

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Hypopharyngeal‐Esophageal Impedance‐pH Monitoring Profiles of Laryngopharyngeal Reflux Patients

Lechien

Bobin²,

Dapri

et al. 2020

The Laryngoscope

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Objectives/Hypothesis To investigate the profile of patients with laryngopharyngeal reflux (LPR) at hypopharyngeal–esophageal multichannel intraluminal impedance‐pH (HEMII‐pH) monitoring and the relationship between hypopharyngeal‐proximal reflux episodes (HREs) and saliva pepsin concentration. Study Design Prospective non‐controlled. Methods Patients were recruited from three European hospitals from January 2018 to October 2019. Patients benefited from HEMII‐pH monitoring and saliva collections to measure saliva pepsin concentration in the same time. Saliva pepsin concentration was measured in the morning (fasting), after lunch, and after dinner. The LPR profile of patients was studied through a breakdown of the HEMII‐pH findings over the 24 hours of testing. The relationship between the concentrations of saliva pepsin and 24‐hour HREs was studied through linear multiple regression. Results One hundred twenty‐six patients completed the study. The HEMII‐pH analyses revealed that 73.99% of HREs occurred outside 1‐hour postmeal times, whereas 20.49% and 5.52% of HREs occurred during the 1‐hour postmeal and nighttime, respectively. Seventy‐four patients (58.73%) did not have nighttime HREs. Patients with both daytime and nighttime HREs had more severe HEMII‐pH parameters and reflux symptom score compared with patients with only daytime HREs. There were no significant associations between HREs and saliva pepsin concentration. Conclusions Unlike gastroesophageal reflux disease, HREs occur less frequently after meals and nighttime. The analysis of the HEMII‐pH profile of the LPR patients has to be considered to develop future personalized therapeutic strategies. Level of Evidence 4 Laryngoscope, 131:268–276, 2021

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Section: Discussionsupporting

confidence: 48%

“…A trained lab technician received the samples the day following the collection. The steps for pepsin measurement were performed in a standardized procedure, which has been previously described 12 . The saliva pepsin concentration was measured using the Cube Reader (opTricon, Berlin, Germany), which detects pepsin down to 16 ng/mL.…”

Section: Methodsmentioning

confidence: 99%

Hypopharyngeal‐Esophageal Impedance‐pH Monitoring Profiles of Laryngopharyngeal Reflux Patients

Lechien

Bobin²,

Dapri

et al. 2020

The Laryngoscope

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“…Furthermore, pepsin may be internalized and reactivated into the Golgi, which is associated with an intracellular toxicity on which the PPIs cannot impact . The intracellular pathway of pepsin and the potential involvement of trypsin, bile salts, and other gastroduodenal enzymes (active at alkaline pH) may explain the resistance to high‐dose PPI therapy in some patients with mixed or nonacid LPR. Thus, the use of alginate or magaldrate in nonacid and mixed LPR patients makes sense.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal reflux in laryngopharyngeal reflux patients: Clinical features and therapeutic response

Lechien¹,

Bobin²,

Muls

et al. 2019

The Laryngoscope

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Objective To investigate the clinical features and the therapeutic response of laryngopharyngeal reflux (LPR) patients with or without gastroesophageal reflux disease (GERD). Methods Patients with LPR symptoms were enrolled from three European Hospitals. The diagnosis of LPR and GERD was made through impedance‐pH monitoring (MII‐pH). A gastrointestinal endoscopy was realized in patients with digestive complaints or ≥60 years old. The 3‐ to 6‐month treatment was based on the association of diet, pantoprazole, alginate, and magaldrate regarding the MII‐pH characteristics. Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA) were used to evaluate the clinical evolution throughout treatment. The gastrointestinal endoscopy findings, clinical features, and therapeutic response were compared between patients with LPR and GERD (LPR/GERD) and patients with LPR. Results One hundred and eleven LPR patients were included, 54 being LPR/GERD. LPR/GERD patients had a higher number of proximal reflux episodes compared with LPR patients. The prevalence of esophagitis, hernia hiatal, and lower esophageal sphincter insufficiency did not differ between groups. The presence of GERD was strongly associated with acid LPR. Patients without GERD had a higher proportion of nonacid and mixed LPR compared with LPR/GERD patients. The pre‐ to posttreatment evolutions of RSS and RSA were quite similar in both groups, with the exception of the 3‐ to 6‐month improvement of digestive symptoms, which was better in LPR/GERD group. The therapeutic success rates were 79.6% and 77.2% in GERD/LPR and LPR group, respectively. Conclusion GERD is predictive of acid LPR. The clinical evolution and the therapeutic response rates were quite similar in both groups. Level of Evidence 4 Laryngoscope, 130: E479–E489, 2020

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“…There would have many grey areas limiting the establishment of clear indications for the peptest. First, the saliva pepsin concentration would be not correlated with the HEMII-pH findings [68]. Second, the diet of patients could have a significant impact on the pepsin saliva concentration [69].…”

Section: Additional Examinationsmentioning

confidence: 99%

Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians

Lechien

Saussez

Muls

et al. 2020

JCM

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Laryngopharyngeal reflux (LPR) is a common disease in the general population with acute or chronic symptoms. LPR is often misdiagnosed in primary care because of the lack of typical gastroesophageal reflux disease (GERD) symptoms and findings on endoscopy. Depending on the physician’s specialty and experience, LPR may be over- or under-diagnosed. Management of LPR is potentially entirely feasible in primary care as long as General Practitioners (GPs) are aware of certain “red flags” that will prompt referral to a Gastroenterologist or an Otolaryngologist. The use of patient-reported outcome questionnaires and the consideration of some easy ways to diagnose LPR without special instrumentation oropharyngeal findings may help the GP to diagnose and often manage LPR. In this review, we provide a practical algorithm for LPR management for GPs and other specialists that cannot perform fiberoptic examination. In this algorithm, physicians have to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and “red flags”. They may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the symptom severity. Proton pump inhibitors and alginates remain a popular choice in order to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

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

Cited by 28 publications

References 19 publications

Hypopharyngeal‐Esophageal Impedance‐pH Monitoring Profiles of Laryngopharyngeal Reflux Patients

Hypopharyngeal‐Esophageal Impedance‐pH Monitoring Profiles of Laryngopharyngeal Reflux Patients

Gastroesophageal reflux in laryngopharyngeal reflux patients: Clinical features and therapeutic response

Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians

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