A Ratio of Sep70 and Pepsin Expression in Hypopharynx Combined with Hypopharyngeal Multichannel Intraluminal Impedance Increases the Diagnostic Sensitivity of Laryngopharyngeal Reflux

Background and Aims: Pepsin in the gastric refluxate is a marker for a prior reflux event and rapid detection might be achieved using the Peptest™, an in vitro diagnostic medical device. The aim of this study was to validate the use of Peptest™ to reliably diagnose reflux in patients with gastro-esophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) disease diagnosed with multichannel intraluminal impedance/ pHmetry (MII-pH). Methods: 20 reflux patients were recruited of whom 10 had classical GERD and 10 had LPR. All patients underwent MII-pH and provided expectorated saliva samples when a MII-pH reflux event was observed, or reflux symptoms were experienced, and all were tested for the presence of pepsin using the Peptest™. Results: Pepsin was detected in 31 out of 45 samples (68.9%). At least 1 positive pepsin result was seen in 16 patients (80%) and this was the same, irrespective of the GERD or LPR diagnosis. Peptest™ had a positive predictive value of 69% to detect MII-pH reflux events. Conclusions: Peptest™ is a good first-line diagnostic procedure to use in reflux sufferers to confirm the presence of reflux.

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Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review

Otolaryngology ◽

10.1177/0194599819827488 ◽

2019 ◽

Vol 160 (5) ◽

pp. 762-782 ◽

Cited By ~ 58

Author(s):

Jerome R. Lechien ◽

Lee M. Akst ◽

Abdul Latif Hamdan ◽

Antonio Schindler ◽

Petros D. Karkos ◽

...

Keyword(s):

Clinical Presentation ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Diagnosis And Treatment ◽

Cochrane Library ◽

Diagnostic Tools ◽

Multichannel Intraluminal Impedance ◽

Intraluminal Impedance ◽

Number Of Patients ◽

Multichannel Intraluminal Impedance Ph

Objective To review the current literature about the epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux (LPR). Data Sources PubMed, Cochrane Library, and Scopus. Methods A comprehensive review of the literature on LPR epidemiology, clinical presentation, diagnosis, and treatment was conducted. Using the PRISMA statement, 3 authors selected relevant publications to provide a critical analysis of the literature. Conclusions The important heterogeneity across studies in LPR diagnosis continues to make it difficult to summarize a single body of thought. Controversies persist concerning epidemiology, clinical presentation, diagnosis, and treatment. No recent epidemiologic study exists regarding prevalence and incidence with the use of objective diagnostic tools. There is no survey that evaluates the prevalence of symptoms and signs on a large number of patients with confirmed LPR. Regarding diagnosis, an increasing number of authors used multichannel intraluminal impedance–pH monitoring, although there is no consensus regarding standardization of the diagnostic criteria. The efficiency of proton pump inhibitor (PPI) therapy remains poorly demonstrated and misevaluated by incomplete clinical tools that do not take into consideration many symptoms and extralaryngeal findings. Despite the recent advances in knowledge about nonacid LPR, treatment protocols based on PPIs do not seem to have evolved. Implications for Practice The development of multichannel intraluminal impedance–pH monitoring and pepsin and bile salt detection should be considered for the establishment of a multiparameter diagnostic approach. LPR treatment should evolve to a more personalized regimen, including diet, PPIs, alginate, and magaldrate according to individual patient characteristics. Multicenter international studies with a standardized protocol could improve scientific knowledge about LPR.

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