Abstract
Background: The PeptestTM is a non-invasive diagnostic test for measuring the pepsin concentration in saliva, which is thought to correlate with laryngopharyngeal reflux (LPR). The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR. Methods: Patients with suspected LPR were examined with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), fasting Peptest, and MII-pH monitoring. We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Peptest, RSI, and RFS based on the threshold of one and six hypopharyngeal reflux episodes. Results: Altogether, the data from 46 patients were analyzed. When one hypopharyngeal reflux episode was used as a diagnostic threshold for LPR, the accuracy, sensitivity, specificity, PPV, and NPV were, respectively, as follows: 35%, 33%, 100%, 100%, and 3%, for the Peptest; 39%, 40%, 0%, 95%, and 0%, for the RSI; and 57%, 58%, 0%, 96%, and 0%, for the RFS. The accuracy, sensitivity, specificity, PPV, and NPV of the Peptest for diagnosing gastroesophageal reflux disease (GERD) were 46%, 27%, 63%, 40.0%, and 48%, respectively. Conclusions: A positive Peptest is highly supportive of a pathological LPR diagnosis. However, a negative test could not exclude LPR.
Highlights
Laryngopharyngeal reflux (LPR) is often involved in the development of laryngeal, pharyngeal, rhinological, and otological conditions [1,2,3,4]
The present study aimed to investigate the diagnostic value of the Peptest compared to that of the gold standard LPR diagnosis based on multichannel intraluminal impedance-pH (MII-pH) monitoring
We investigated the diagnostic value of the Peptest for diagnosing gastroesophageal reflux (GERD) based on a positive DeMeester score
Summary
Laryngopharyngeal reflux (LPR) is often involved in the development of laryngeal, pharyngeal, rhinological, and otological conditions [1,2,3,4]. The precise diagnosis of LPR remains challenging, in patients with mild to moderate symptoms, because the symptoms and findings are nonspecific, and an accepted gold standard does not exist, as every diagnostic method shows false positive and false negative results. Monitoring tool, which provides useful information about the severity, number, and type (acid, nonacid, mixed, upright/recumbent) of hypopharyngeal reflux episodes. MII-pH monitoring might be inconvenient for some patients, is costly, and is not available at all institutions [1]. New non-invasive diagnostic approaches have been developed, including the detection of pepsin in saliva samples with the PeptestTM (RD Biomed, Hull, UK) [5]. The Peptest measures the pepsin concentration in saliva, which is thought to correlate with recent (i.e., within hours) hypopharyngeal reflux episodes
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