Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad
Introduction 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....
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doaj-8005b75715524d279dde1dde995a4a292021-05-04T22:34:04ZengThieme Revinter Publicações Ltda.International Archives of Otorhinolaryngology1809-97771809-48642021-04-012502e273e27810.1055/s-0040-1709987Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic TriadShilpa Divakaran0Sivaa Rajendran1Roshan Marie Thomas2Jaise Jacob3Mary Kurien4Department of ENT, NMC Specialty Hospital, Muscat, OmanDepartment of Biochemistry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, IndiaDepartment of ENT, City Hospital , Kochi, Kerala, IndiaDepartment of Biochemistry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, IndiaDepartment of Biochemistry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, IndiaIntroduction 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. Objective 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. Methods 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. Results 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 (p < 0.0001). Conclusion 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1709987reflux findings scorereflux symptoms indexsalivapepsinlaryngopharyngeal reflux |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shilpa Divakaran Sivaa Rajendran Roshan Marie Thomas Jaise Jacob Mary Kurien |
spellingShingle |
Shilpa Divakaran Sivaa Rajendran Roshan Marie Thomas Jaise Jacob Mary Kurien Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad International Archives of Otorhinolaryngology reflux findings score reflux symptoms index saliva pepsin laryngopharyngeal reflux |
author_facet |
Shilpa Divakaran Sivaa Rajendran Roshan Marie Thomas Jaise Jacob Mary Kurien |
author_sort |
Shilpa Divakaran |
title |
Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad |
title_short |
Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad |
title_full |
Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad |
title_fullStr |
Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad |
title_full_unstemmed |
Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad |
title_sort |
laryngopharyngeal reflux: symptoms, signs, and presence of pepsin in saliva - a reliable diagnostic triad |
publisher |
Thieme Revinter Publicações Ltda. |
series |
International Archives of Otorhinolaryngology |
issn |
1809-9777 1809-4864 |
publishDate |
2021-04-01 |
description |
Introduction 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.
Objective 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.
Methods 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.
Results 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 (p < 0.0001).
Conclusion 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. |
topic |
reflux findings score reflux symptoms index saliva pepsin laryngopharyngeal reflux |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1709987 |
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