Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux

Yıl 2015, Cilt: 32 Sayı: 1, 46 - 50, 01.01.2015

Emre Ocak Gözde Kubat İrfan Yorulmaz

Öz

Background: The most common tool for the diagnosis of laryngopharyngeal reflux (LPR) is still 24-hours esophageal pH monitoring; there is lack of non-invasive, less expensive and accurate diagnostic tools for this frequent disease. Aims: To evaluate the accuracy of immunoserologic pepsin detection in the saliva for the diagnosis of LPR. Study Design: Cross-sectional study. Methods: A two channeled 24-hour esophageal pH monitoring catheter was placed in patients with a suspicion of LPR. During the 24-hour period, each patient gave one sample of sputum for the immunoserologic pepsin detection test. Pathologic gastroesophageal reflux (GER) findings, LPR findings, pH score in the proximal and distal probes when the sputum sample was given were recorded. The sensitivity, specificity, positive and negative predictive values of the pepsin detection test were analyzed and compared to pH monitoring scores. Results: The study group consisted of 20 patients who met the criteria. A positive pepsin detection test was elicited from 6 patients. The sensitivity and specificity of the pepsin detection test was 33% and 100%, respectively. A positive predictive value of 100% was recorded. When the pH results of the pepsin positive patients (PPP) and the rest of the study group in the proximal probe at the sample time were compared, the PPP had an apparent acidic pH value compared to the pepsin negative patients (pH: 3.26 for the PPP, pH: 6.81 for the pepsin negative patients). Conclusion: Pepsin detection in the saliva is a recent method and becoming increasingly popular. Because of the benefits and ease of application, a positive salivary pepsin test in a patient suspected of having LPR can be a cost effective, accurate and alternative diagnostic method. Increasing the daily number of sputum samples may increase the sensitivity of the test. Total Times Cited: 10 (Updated on Sep. 2018- WoS)

Anahtar Kelimeler

Diagnosis, pepsin, reflux, saliva

Kaynakça

• 1. Koufman JA. Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J 2002;81(Suppl 2):7-9.
• 2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-20. [CrossRef]
• 3. Koufman J, Sataloff RT, Toohill R. Laryngopharyngeal reflux: consensus conference report. J Voice 1996;10:215-6. [CrossRef] 4. Belafsky PC, Postma GN, Daniel E, Koufman JA. Transnasal esophagoscopy. Otolaryngol Head Neck Surg 2001;125:588-9. [CrossRef]
• 5. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101(Suppl 53):1-78.
• 6. Grøntved ÅM, West F. pH monitoring in patients with benign voice disorders. Acta Otolaryngol Suppl 2000;120:229-31. [CrossRef] 7. Johnson PE, Koufman JA, Nowak LJ, Belafsky PC, Postma GN. Ambulatory 24-Hour Double-Probe pH Monitoring: The Importance of Manometry. Laryngoscope 2001;111:1970-5. [CrossRef]
• 8. Bulmer DM, Ali MS, Brownlee IA, Dettmar PW, Pearson JP. Laryngeal mucosa: its susceptibility to damage by acid and pepsin. Laryngoscope 2010;120:777-82. [CrossRef]
• 9. Sole ML, Conrad J, Bennett M, Middleton A, Hay K, Ash-worth S, Mehta DI. Pepsin and amylase in oral and tracheal secretions: a pilot study. Am J Crit Care 2014;23:334-8. [CrossRef]
• 10. Dinis PB, Subtil J. Helicobacter pylori and laryngopharyngeal reflux in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2006;134:67-72. [CrossRef]
• 11. Krishnan U, Mitchell JD, Messina I, Day AS, Bohane TD. Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr 2002;35:303-8. [CrossRef]
• 12. Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274-7. [CrossRef] 13. Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001;111:1313-7. [CrossRef]
• 14. Yuksel ES, Hong S-KS, Strugala V, Slaughter JC, Goutte M, Garrett CG, et al. Rapid Salivary Pepsin Test: Blinded Assessment of Test Performance in Gastroesophageal Reflux Disease. Laryngoscope 2012;122:1312-6. [CrossRef]
• 15. Knight J, Lively MO, Johnston N, Dettmar PW, Koufman JA. Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux. Laryngoscope 2005;115:1473-8. [CrossRef]
• 16. Bollschweiler E, Feussner H, Hölscher AH, Siewert J. pH monitoring: the gold standard in detection of gastrointestinal reflux disease? Dysphagia 1993;8:118-21. [CrossRef]
• 17. Tseng D, Rizvi AZ, Fennerty MB, Jobe BA, Diggs BS, Sheppard BC, et al. Forty-eight-hour pH monitoring increases sensitivity in detecting abnormal esophageal acid exposure. J Gastrointest Surg 2005;9:1043-52. [CrossRef]
• 18. Jiang A, Liang M, Su Z, Chai L, Lei W, Wang Z, et al. Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux. Laryngoscope 2011;121:1426-30. [CrossRef]
• 19. Vaezi MF. Gastroesophageal reflux disease and the larynx. J Clin Gastroenterol 2003;36:198-203. [CrossRef]
• 20. Postma GN, Belafsky PC, Aviv JE, Koufman JA. Laryngopharyngeal reflux testing. Ear Nose Throat J 2002;81:14-8.
• 21. Wise JL, Murray JA. Utilising multichannel intraluminal impedance for diagnosing GERD: a review. Dis Esophagus 2007;20:83-8. [CrossRef]
• 22. Dunn BM. Structure and mechanism of the pepsin-like family of aspartic peptidases. Chem Rev 2002;102:4431-58. [CrossRef]
• 23. Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoscope 2007;117:1036-9. [CrossRef]
• 24. Samuels TL, Johnston N. Pepsin as a causal agent of inflammation during nonacidic reflux. Otolaryngol Head Neck Surg 2009;141:559-63. [CrossRef]
• 25. Jiang A, Liang M, Su Z, Chai L, Lei W, Wang Z, et al. Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux. Laryngoscope 2011;121:1426-30. [CrossRef]
• 26. Kim TH, Lee KJ, Yeo M, Kim DK, Cho SW. Pepsin detection in the sputum/saliva for the diagnosis of gastroesophageal reflux disease in patients with clinically suspected atypical gastroesophageal reflux disease symptoms. Digestion 2008;77:201-6. [CrossRef]
• 27. Potluri S, Friedenberg F, Parkman HP, Chang A, MacNeal R, Manus C, et al. Comparison of a salivary/sputum pepsin assay with 24-hour esophageal pH monitoring for detection of gastric reflux into the proximal esophagus, oropharynx, and lung. Dig Dis Sci 2003;48:1813-7. [CrossRef]
• 28. Samuels TL, Johnston N. Pepsin as a marker of extraesophageal reflux. Ann Otol Rhinol Laryngol 2010;119:203-8.