Original articleAlimentary tractAbilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation
Section snippets
Methods
The Northwestern University institutional review board approved the study protocol.
We conducted a physician-blinded prospective cohort pilot study at a single academic medical center. Adult subjects were recruited from January 2014 to February 2015. Subjects were excluded if pregnant, allergic to anesthetic spray used during laryngoscopy, unable to discontinue PPI for 5 days before initial testing, or because of the presence of significant comorbidities compromising the subject’s health and
Results
Fifty-nine subjects were recruited; 20 were healthy volunteers, 20 met criteria for the laryngeal cohort, and 19 met criteria for the laryngeal + reflux cohort. Two subjects from each cohort, a total of 6 subjects, were excluded because of oropharyngeal pH data recording error. Thus, 53 subjects were included in the oropharyngeal pH analysis: 18 controls, 18 laryngeal, and 17 laryngeal + reflux. Saliva samples were collected from 35 total subjects: 20 controls, 6 laryngeal, and 9 laryngeal +
Conclusions
Minimally invasive diagnostic tools to identify patients with LPR are needed; thus, we examined the ability of 2 novel diagnostic modalities, oropharyngeal pH testing and salivary pepsin analysis, to reliably discriminate between asymptomatic and symptomatic patients. On the basis of current normative thresholds both oropharyngeal pH testing with the Restech Dx-pH system and salivary pepsin analysis with Peptest could not distinguish between healthy volunteers and symptomatic subjects. Trends
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Diagnosing Laryngopharyngeal Reflux: A Comparison between 24-hour pH-Impedance Testing and Pharyngeal Probe (Restech) Testing, with Introduction of the Sataloff Score
2023, Journal of VoiceCitation Excerpt :Further research is needed to investigate this speculation. Without an adequate barrier to refluxate, the oropharynx will be unable to mitigate pepsin deposition.17-21 In this study, Restech demonstrated a significant correlation with RSI, possibly due to inflammation from refluxate in the oropharynx for prolonged periods of time.
AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review
2023, Clinical Gastroenterology and HepatologyDiagnostic utility of salivary pepsin in laryngopharyngeal reflux: a systematic review and meta-analysis
2023, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :Fagan plots manifested a PLR of 2 and a NLR of 0.58, with 65% and 37% of the posttest probability for PLR and NLR, respectively (Fig. 3d). Of these 16 studies, the cutoff value of 16 ng/mL was utilized in six studies;13,14,20–23 and the cutoff value of 50 ng/mL was used in four studies.14,18,21,25 In addition, other used cutoff values were 25 ng/mL, 74 ng/mL, 75 ng/mL, 100 ng/mL, 150 ng/mL, 210 ng/mL, and 216 ng/mL.
Predictive Value of Laryngeal Mucosa Pepsin in Therapeutic Response of Laryngopharyngeal Reflux
2022, Journal of VoiceCitation Excerpt :However, saliva or sputum pepsin concentrations vary throughout the day12,16 and tend to be affected by external factors such as the food type,17 the time of eating,18 swallowing, or spitting, making it difficult to determine the optimal sampling time. A study conducted by Yadlapati et al found that Peptest™ was not able to distinguish between healthy volunteers and subjects with a combination of laryngeal and reflux symptoms.19 Another two meta-analyses20,21 also concluded that pepsin in saliva/sputum had only moderate value in the diagnosis of LPR.
Conflicts of interest These authors disclose the following: Rena Yadlapati is supported by T32 DK101363-02 grant. John E. Pandolfino is a consultant for Covidien, Sandhill Scientific, and Given. The remaining authors disclose no conflicts.