Studies of salivary pepsin in patients with gastro‐oesophageal reflux disease

Abstract

Background: Gastro-oesophageal reflux disease (GERD) is difficult to diagnose without invasive testing. Peptest (RD Biomed, Hull, UK) is a recently marketed diagnostic tool which aims to quantify salivary pepsin as a marker of reflux, providing a rapid alternative to invasive procedures. Aim:To evaluate optimal timing for sampling, and to evaluate the accuracy of Peptest against an independent measure. Methods: Thirty diagnosed GERD patients (12 female, mean age 49 [range 20-72])and 20 asymptomatic subjects (14 female, mean age 56 [range 21-56]) were subject to diurnal saliva sampling, with additional samples for 60 minutes following self-reported reflux symptoms and triggering of a proximal reflux alarm. Saliva samples were split and were analysed by both Peptest and ELISA with operators for each blinded to sample identity.Results: Salivary pepsin was detectable in most patients and most volunteers. Peptest scores were significantly lower for patients than controls (P < 0.005). ELISA scores showed no difference between patients and controls. There was no effect of diurnal sampling time (P = 0.75) or time after symptoms (P = 0.76) on Peptest readout. There was no correlation between Peptest and Pepsin ELISA (P = 0.55);Bland-Altman analysis suggested no agreement between the tests (P = 0.414).Receiver-operator curve suggests that neither Peptest (P = 0.3328) nor pepsin (P = 0.4476) is useful for predicting GERD.Conclusion: Salivary pepsin is not a reliable tool for the diagnosis of GERD.Caroline Race and Joanna Chowdry made an equal contribution to this work. Bernard M. Corfe and Stuart A. Riley made an equal contribution to this work.

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

“…A promising non-invasive test to diagnose reflux, although still controversial in its clinical applications, is the salivary detection of pepsin [43,44]. Pepsin is a proteolytic enzyme secreted in the gastric fundus as pepsinogen and activated in the acidic environment: its identification in non-gastric sites can detect the presence of significant reflux.…”

Salivary peptest for laryngopharyngeal reflux and gastroesophageal reflux disease

“…1) to detect pepsin in saliva/sputum has shortened the salivary pepsin assay to several minutes and offered a strong predictive value for LRPD/GERD diagnosis [22] . There are several studies evaluating the diagnostic value of Peptest for LRPD/GERD, but they showed different results [19,22,28–41] …”

GERD-related chronic cough: Possible mechanism, diagnosis and treatment

“…Unfortunately, the current data are inconclusive or negative ( Ocak et al, 2015 ; Yadlapati et al, 2016 ). For example, despite the fact that salivary pepsin has been proven in some studies to aid in the diagnosis of laryngopharyngeal reflux ( Hayat et al, 2014 ; Sereg-Bahar et al, 2015 ; Spyridoulias et al, 2015 ), recent studies have failed to demonstrate the test’s clinical utility ( Yadlapati et al, 2016 ; Race et al, 2019 ). Defining the optimal saliva collection protocol, or detecting pepsin by other means such as sputum, may aid in the development of this test as a viable GERC detection tool.…”