Salivary pepsin A detection related to gastro‐oesophageal reflux episodes in children undergoing impedance probe monitoring

Haddad, Hadeel Alatrash; He, Zhaoping; Shaffer, Stephen; Molle-Rios, Zarela

doi:10.1111/apa.15276

Cited by 6 publications

(4 citation statements)

References 23 publications

(60 reference statements)

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“…Evaluation of MII in conjunction with TA pepsin A activity would facilitate the accurate quantification of each reflux episode and provide anatomic characterization of each episode with respect to proximal extent of gastric contents. Recently, salivary pepsin A was associated with GER episode in pediatric patients undergoing MII probe monitoring (43). Further studies evaluating salivary pepsin A in relation to TA pepsin A and MII/ pH studies are warranted to explore the utility of biomarker pepsin A to detect microaspiration.…”

Section: Discussionmentioning

confidence: 99%

Oral Care Associated With Less Microaspiration in Ventilated Cardiac Patients

et al. 2023

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Background and Objective: Aspiration is common in mechanically ventilated patients and may predispose patients to aspiration pneumonia, chemical pneumonitis, and chronic lung damage. Pepsin A is a specific marker of gastric fluid aspiration and is often detected in ventilated pediatric patients. We investigated the effect of oral care and throat suctioning in the detection of pepsin A in tracheal aspirates (TAs) up to 4 hours after these procedures. Methods: Twelve pediatric patients between age 2 weeks to 14 years who underwent intubation for cardiac surgery were enrolled in this study. Six of the 12 patients were consented before their surgery with initial specimen collected at the time of intubation and last one shortly before extubation (intubation duration < 24 hours). The remaining 6 patients were consented after cardiac surgery. All specimens were collected per routine care per respiratory therapy protocol and shortly before extubation (intubation duration > 24 hours). Tracheal fluid aspirates were collected every 4 to 12 hours in the ventilated patients. Enzymatic assay for gastric pepsin A and protein determination were performed. The time of oral care and throat suctioning within 4 hours prior was recorded prospectively. Results: A total of 342 TA specimens were obtained from the 12 intubated pediatric patients during their course of hospitalization; 287 (83.9%) showed detectable total pepsin (pepsin A and C) enzyme activity (> 6 ng/mL) and 176 (51.5%) samples had detectable pepsin A enzyme levels (>6 ng/mL of pepsin A). Only 29 samples of 76 samples (38.2%) had evidence of microaspiration after receiving oral care, while 147 of 266 (55.3%) samples were pepsin A positive when no oral care was provided. Odds ratio is 0.50 (Cl 0.30–0.84), and the number needed to treat is 5.8 (Confidence interval 3.4–22.3). Testing air filters for pepsin was not beneficial. Conclusion: Oral care is a highly effective measure to prevent microaspiration of gastric fluid in ventilated pediatric patients. The number needed to treat (5.8) suggests this is a very effective prevention strategy. Our study suggests that pepsin A is a useful and sensitive biomarker that allows identification of gastric aspiration.

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Section: Discussionmentioning

confidence: 99%

Oral Care Associated With Less Microaspiration in Ventilated Cardiac Patients

et al. 2023

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“…Among pepsin A positive samples, 72% of samples corresponded to a gastroesophageal reflux episode. The authors reported that pepsin peak levels were significantly correlated with acid GERD [ 82 ]. The usefulness of pepsin measurement in pediatric patients was supported by Klimara et al in a controlled study where authors compared pepsin saliva measurements between pediatric patients with laryngomalacia and healthy controls [ 38 ].…”

Section: Diagnosticmentioning

confidence: 99%

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

Lechien

2023

Children

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Purpose: Pediatric laryngopharyngeal reflux (P-LPR) is associated with the development of common otolaryngological symptoms and findings. In the present study, the findings about epidemiology, clinical presentation, diagnostic and therapeutic outcomes of pediatric population were reviewed. Methods: A PubMed, Cochrane Library, and Scopus literature search was conducted about evidence-based findings in epidemiology, clinical presentation, diagnostic and therapeutic outcomes of P-LPR. Findings: The prevalence of LPR remains unknown in infant and child populations. The clinical presentation depends on age. Infants with LPR symptoms commonly have both gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux and related digestive, respiratory and ear, nose and throat symptoms. The GERD prevalence appears to decrease over the growth, and the clinical picture is increasingly associated with LPR symptoms and findings without GERD. The prevalence of LPR and proximal acid and nonacid esophageal reflux events may be high in some prevalent otolaryngological conditions (chronic otitis media, laryngolomalacia and apnea). However, the lack of use of hypopharyngeal–esophageal multichannel intraluminal impedance pH monitoring (HEMII-pH) limits the establishment of etiological associations. Proton pump inhibitors are less effective in P-LPR patients compared to GERD populations, which may be related to the high prevalence of weakly or nonacid reflux events. Conclusions: Many gray areas persist in P-LPR and should be not resolved without the establishment of diagnostic criteria (guidelines) based on HEMII-pH. The unavailability of HEMII-pH and the poor acid-suppressive therapeutic response are all issues requiring future investigations. Future controlled studies using HEMII-pH and enzyme measurements in ear, nose or throat fluids may clarify the epidemiology of P-LPR according to age and its association with many otolaryngological conditions.

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“…[12][13][14] The gastric enzyme pepsin is present in all refluxate and has been validated as a sensitive and specific marker of EER. [15][16][17][18] MEF pepsin is present in $85% of pediatric ROM and OME cases. 10 The high incidence and predominantly weakly acid nature of EER in OM have been corroborated by pH-multichannel intraluminal impedance testing (pH-MII), which identified 68% incidence of EER in OME with 88% of reflux events >pH 5.…”

Section: Introductionmentioning

confidence: 99%

“…EER is extensively buffered in transit to the airways and is commonly weakly or non‐ acidic, yet airway mucosa is susceptible to damage by nonacid elements of EER and weak to non‐ acid EER is associated with respiratory symptoms in adults and children 12–14 . The gastric enzyme pepsin is present in all refluxate and has been validated as a sensitive and specific marker of EER 15–18 . MEF pepsin is present in ~85% of pediatric ROM and OME cases 10 .…”

Section: Introductionmentioning

confidence: 99%

Association of Pepsin With Inflammatory Signaling and Effusion Viscosity in Pediatric Otitis Media

et al. 2021

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Objective: Otitis media (OM) is a common inflammatory disease spectrum. Cytokine signaling, neutrophil activity, and mucin hypersecretion during recurrent and chronic OM contribute to persistent, viscous middle ear (ME) effusions, hearing loss, and potential for developmental delay. Extraesophageal reflux (EER), specifically pepsin, triggers inflammatory signaling in respiratory mucosa and is associated with OM. The objective of this study was to investigate the association of pepsin with ME inflammatory signaling and the outcomes and examine causality in vitro.Study Design: Cross-sectional study. Methods: ME fluid (MEF) and preoperative audiometric data were collected from 30 pediatric subjects undergoing tympanostomy tube placement for recurrent OM or OM with effusion. MEF viscosity was characterized by the surgeon. Pepsin, inflammatory molecules, and mucin were assayed by enzyme-linked immunosorbent assay (ELISA). ME epithelial primary culture was exposed to 0.1 to 1 mg/ml pepsin at pH 5, 6, and 7 for 30 minutes, and cytokine expression was assayed via qPCR.Results: Pepsin was observed in the MEF of 77% of patients (range 71-2,734 ng/ml). Pepsin correlated with effusion viscosity, interleukins À6 and À8, neutrophil elastase, and mucin 5B (P < .05). Pepsin-negative MEF was more frequently absent of interleukin 8 or mucin 5B (P < .05). Weak acid was generally insufficient to elicit cytokine expression in ME cells in vitro, however, pepsin induced IL6, IL8, and TNF at pH 7 (P < .05) and weak acid (pH 6) facilitated a response at lower pepsin concentration.Conclusions: Pepsin may contribute to inflammatory signaling, persistent viscous effusion, and poorer OM outcomes.

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Salivary pepsin A detection related to gastro‐oesophageal reflux episodes in children undergoing impedance probe monitoring

Cited by 6 publications

References 23 publications

Oral Care Associated With Less Microaspiration in Ventilated Cardiac Patients

Oral Care Associated With Less Microaspiration in Ventilated Cardiac Patients

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

Association of Pepsin With Inflammatory Signaling and Effusion Viscosity in Pediatric Otitis Media

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