Division of Laryngology and Bronchoesophagology, Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Foch Hospital, University Paris Saclay, Paris, France.
Eur Arch Otorhinolaryngol. 2024 Feb;281(2):827-833. doi: 10.1007/s00405-023-08317-x. Epub 2023 Oct 31.
To study the diagnostic value of salivary pepsin tests for detecting laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS).
Patients with BMS and asymptomatic individuals were consecutively recruited from September 2018 to June 2023. Patients underwent hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH) and saliva collections to measure pepsin. Stomatology evaluation was carried out to exclude other causes of BMS. Oral, pharyngeal and laryngeal signs and symptoms were evaluated with Reflux Sign Assessment (RSA) and Reflux Symptom Score (RSS). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin test were calculated considering the highest values of pepsin tests at ≥ 16, ≥ 36, and ≥ 100 ng/mL cutoffs. Receiver operating characteristic curve (ROC) was evaluated.
Forty-nine patients with both BMS and LPR at the HEMII-pH and 21 asymptomatic individuals were recruited. Pepsin test was 83.7%, 79.6%, and 71.4% sensitive at cutoffs ≥ 16, ≥ 36, and ≥ 100 ng/mL, respectively. The ROC analysis reported that a threshold of ≥ 21.5 ng/mL was associated with sensitivity, specificity, PPV and NPV of 81.6%, 81.0%, 90.1% and 65.4%, respectively. The severity score of burning mouth symptom was significantly associated with the saliva pepsin concentration (r = 0.263; p = 0.029) and the oral RSA (r = 0.474; p = 0.007).
Pepsin test is a valuable diagnostic approach for detecting LPR in patients with BMS. Patients with high level of saliva pepsin reported more severe burning mouth symptoms. Future studies are needed to confirm the role of LPR in the primary BMS.
研究唾液胃蛋白酶检测对原发性灼口综合征（BMS）患者检测咽食管反流（LPR）的诊断价值。
2018 年 9 月至 2023 年 6 月连续招募 BMS 患者和无症状个体。患者接受食管阻抗-pH 监测（HEMII-pH）和唾液采集以测量胃蛋白酶。进行口腔学评估以排除 BMS 的其他原因。使用反流症状评估（RSA）和反流症状评分（RSS）评估口腔、咽和喉体征和症状。考虑到胃蛋白酶检测在≥16、≥36 和≥100 ng/mL 截点时的最高值，计算胃蛋白酶检测的灵敏度、特异性、阳性（PPV）和阴性（NPV）预测值。评估接收者操作特征曲线（ROC）。
HEMII-pH 上同时患有 BMS 和 LPR 的 49 名患者和 21 名无症状个体被招募。胃蛋白酶检测在截点≥16、≥36 和≥100 ng/mL 时的灵敏度分别为 83.7%、79.6%和 71.4%。ROC 分析报告，阈值≥21.5 ng/mL 与 81.6%、81.0%、90.1%和 65.4%的灵敏度、特异性、PPV 和 NPV 相关。灼口症状严重程度评分与唾液胃蛋白酶浓度（r=0.263；p=0.029）和口腔 RSA（r=0.474；p=0.007）显著相关。
胃蛋白酶检测是检测 BMS 患者 LPR 的一种有价值的诊断方法。报告高唾液胃蛋白酶水平的患者灼口症状更严重。需要进一步研究来证实 LPR 在原发性 BMS 中的作用。
