Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
Eur Arch Otorhinolaryngol. 2023 Aug;280(8):3765-3771. doi: 10.1007/s00405-023-08000-1. Epub 2023 May 4.
To study the diagnostic value of salivary pepsin measurement (Peptest) for detecting gastroesophageal reflux disease (GERD) in laryngopharyngeal reflux (LPR) patients.
Patients with reflux symptoms were consecutively recruited from January 2020 to November 2022. Patients benefited from hypopharyngeal-esophageal impedance-pH monitoring (HEMII-pH), fasting and bedtime saliva collections to measure pepsin. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were evaluated for GERD and LPR patients considering the highest values of pepsin tests at ≥ 16, ≥ 75, and ≥ 216 ng/mL cutoffs. The relationship between HEMII-pH, endoscopic and clinical findings, and pepsin measurements was studied.
Saliva was collected in 109 LPR patients and 30 individuals with both LPR and GERD. The total number of pharyngeal reflux events was significantly higher in GERD-LPR patients compared with LPR patients (p = 0.008). The mean fasting and bedtime pepsin saliva concentrations were similar between groups. The sensitivity of Peptest in LPR patients was 30.5%, 70.2%, and 84.0% at cutoffs ≥ 16, ≥ 75 and ≥ 216 ng/mL. In GERD-LPR group, Peptest was 80.0%, 70.0%, and 30.0% sensitive. At cutoff 16 ng/mL, Peptest reported PPV of 20.7% and 94.8% in LPR-GERD and LPR groups, respectively. NPV were 73.9% and 8.7% in GERD-LPR and LPR groups, respectively. The consistency analysis between Peptest and HEMII-pH was not significant. Peptest was significantly associated with the number of acid pharyngeal reflux events (r = 0.182; p = 0.032).
Pepsin saliva measurements appear to be not a reliable diagnostic tool for the detection of GERD in LPR patients. Future studies are needed to determine the place of Peptest in laryngopharyngeal reflux and gastroesophageal reflux diseases.
研究唾液胃蛋白酶检测（Peptest）在检测咽喉反流（LPR）患者胃食管反流病（GERD）中的诊断价值。
2020 年 1 月至 2022 年 11 月连续招募有反流症状的患者。对患者进行食管高分辨率多通道腔内阻抗-pH 监测（HEMII-pH）、空腹和睡前唾液采集以测量胃蛋白酶。评估 Peptest 在 GERD 和 LPR 患者中以 16ng/ml、75ng/ml 和 216ng/ml 为截断值时的最高胃蛋白酶检测值的 GERD 和 LPR 患者的敏感性、特异性、阳性（PPV）和阴性（NPV）预测值。研究了 HEMII-pH、内镜和临床发现与胃蛋白酶测量之间的关系。
共收集了 109 例 LPR 患者和 30 例 LPR 和 GERD 并存患者的唾液。与 LPR 患者相比，GERD-LPR 患者的咽部反流事件总数明显更高（p=0.008）。空腹和睡前胃蛋白酶唾液浓度在组间相似。Peptest 在 LPR 患者中的敏感性分别为 16ng/ml 时 30.5%、75ng/ml 时 70.2%和 216ng/ml 时 84.0%。在 GERD-LPR 组中，Peptest 分别为 80.0%、70.0%和 30.0%敏感。在 16ng/ml 时，Peptest 在 LPR-GERD 和 LPR 组中的 PPV 分别为 20.7%和 94.8%。在 GERD-LPR 和 LPR 组中，NPV 分别为 73.9%和 8.7%。Peptest 与 HEMII-pH 的一致性分析不显著。Peptest 与酸性咽反流事件数量显著相关（r=0.182；p=0.032）。
胃蛋白酶唾液测量似乎不是检测 LPR 患者 GERD 的可靠诊断工具。需要进一步的研究来确定 Peptest 在咽喉反流和胃食管反流病中的地位。
