Divakaran Shilpa, Rajendran Sivaa, Thomas Roshan Marie, Jacob Jaise, Kurien Mary
Department of ENT, NMC Specialty Hospital, Muscat, Oman.
Department of Biochemistry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India.
Int Arch Otorhinolaryngol. 2021 Apr;25(2):e273-e278. doi: 10.1055/s-0040-1709987. Epub 2020 Jun 30.
Twenty-four-hour multichannel intraluminal impedance with double probe pH monitoring (MII-pH), though considered the most sensitive tool for the diagnosis of gastroesophageal reflux disease (GERD), is invasive, time consuming, not widely available, and unable to detect non-acid reflux. In contrast, the presence of pepsin in the saliva would act as a marker for reflux, considering that pepsin is only produced in the stomach. To evaluate the predictive value of salivary pepsin in diagnosing laryngopharyngeal reflux (LPR) as suggested by the results of reflux symptom index (RSI > 13), reflux finding score (RFS > 7), and positive response to treatment with a 4-week course of proton-pump inhibitors. This prospective study was done at a tertiary care hospital on 120 adult patients attending ENT OPD with clinical diagnosis of LPR. The presence of pepsin in their pharyngeal secretions and saliva using a lateral flow device, the Peptest, was compared with RSI, RFS, and with the response to medical treatment using the Chi-squared test. Salivary pepsin was found to be positive in 68% of the patients, with 87.5% of them showing positive response to treatment. Chi-squared analysis showed a significant association between positive salivary pepsin and RFS > 7, RSI >13, a combination of RFS > 7 and RSI > 13 as well as with response to treatment ( < 0.0001). When considered along with the clinical indicators of RFS and RSI of more than 7 and 13, respectively, and/or with a response to treatment, a positive salivary pepsin test indicates statistically significant chance of presence of LPR.
24小时多通道腔内阻抗联合双探头pH监测（MII-pH）虽被认为是诊断胃食管反流病（GERD）最敏感的工具，但具有侵入性、耗时、应用不广泛且无法检测非酸性反流的缺点。相比之下，考虑到胃蛋白酶仅在胃中产生，唾液中胃蛋白酶的存在可作为反流的标志物。 为评估反流症状指数（RSI＞13）、反流发现评分（RFS＞7）以及质子泵抑制剂4周疗程治疗反应阳性结果所提示的唾液胃蛋白酶在诊断喉咽反流（LPR）中的预测价值。 这项前瞻性研究在一家三级医疗中心进行，纳入了120例因临床诊断为LPR而就诊于耳鼻喉科门诊的成年患者。使用侧向流动装置Peptest检测其咽部分泌物和唾液中胃蛋白酶的存在情况，并与RSI、RFS以及药物治疗反应进行卡方检验比较。 结果发现68%的患者唾液胃蛋白酶呈阳性，其中87.5%的患者对治疗有阳性反应。卡方分析显示唾液胃蛋白酶阳性与RFS＞7、RSI＞13、RFS＞7和RSI＞13的组合以及治疗反应之间存在显著关联（ ＜0.0001）。 当与RFS和RSI分别大于7和13的临床指标以及/或治疗反应一起考虑时，唾液胃蛋白酶检测呈阳性表明存在LPR具有统计学意义上的显著可能性。
