Original ArticlesSalivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease
Section snippets
Methods
This was a prospective cross-sectional study of children aged 1-19 years undergoing pH-MII testing and esophagogastroduodenoscopy for the evaluation of GERD. Patients who had undergone fundoplication or previous esophageal or gastric surgery were excluded. Approval was granted by our hospital's Institutional Review Board, and informed consent was obtained from each patient or adult guardian.
Recruited patients were asked to provide a random saliva sample for pepsin testing. Alternatively, for
Results
Fifty patients, including 34 boys (68%), with a mean age of 8.7 ± 5.3 years, were recruited. Eleven patients (22%) had abnormal impedance studies, and 19 patients (38%) had abnormal pH monitoring. Twenty-four patients (48%) remained on acid-suppression therapy while undergoing pH-MII testing; there was no significant difference across reflux variables between patients receiving and those not receiving these medications (P > .05). Twenty-one patients (42%) had pepsin detected in the saliva
Discussion
The paradigm that gastroesophageal reflux (GER) is one of the most common causes of chronic cough has greatly influenced clinical practice for over 2 decades.20, 21, 22 It has spurred an enormous increase in acid-suppression therapy among children, even when clinical trials have failed to find a consistent relationship between measured reflux and clinical response.23, 24, 25, 26
Cough and GER are separate commonplace occurrences in children, and thus establishing causality is extremely
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Diagnostic utility of salivary pepsin in laryngopharyngeal reflux: a systematic review and meta-analysis
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Supported by Boston Translational Research Program, the North American Society for Pediatric Gastroenterology Hepatology and Nutrition/Astra Award for Diseases of the Upper Tract, and the National Institutes of Health (R01 DK097112-01A1). The authors declare no conflicts of interest.