Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux

Rocco Plateroti,Marta Sacchetti,Alice Bruscolini,Andrea Maria Plateroti,Giuseppe Magliulo,Alessandro Lambiase,Annalisa Pace,Antonietta Moramarco

doi:10.3390/life10090202

Abstract

Background: patients with laryngopharyngeal reflux (LPR) showed detectable levels of tear pepsin that explain the nasolacrimal obstruction. The purpose of this study was to determine whether patients with LPR show ocular surface changes and to investigate the relationship between lacrimal pepsin concentration and ocular alterations. Methods: Fifty patients with positive endoscopic signs for LPR and an equal or higher score of 13 and 7 for Reflux Symptom Index and Reflux Finding Score were enrolled. Twenty healthy patients with no reflux disease and dry eye were included as the control group. After evaluation of ocular discomfort symptoms, the tear break-up time test, corneal staining, and tear sampling were performed. Tear pepsin levels were measured using Pep-testTM kit. Results: Patients with LPR showed ocular surface changes including epithelial damage (48%) and impairment of lacrimal function (72%). Tear pepsin levels were detectable in 32 out of 50 (64%) patients with LPR (mean ± SD: 55.4 ± 67.5 ng/mL) and in none of the control subjects. Most of the LPR patients complained of ocular discomfort symptoms, including itching (38%), redness (56%), or foreign body sensation (40%). Tear pepsin levels were significantly correlated with the severity of LPR disease and with ocular surface changes. Conclusions: A multidisciplinary approach, including ophthalmological evaluation, should be considered in order to improve the management of patients with LPR.

Highlights

Laryngopharyngeal reflux (LPR) is a disease characterized by retrograde reflux of gastric and/or duodenal contents through the upper esophageal sphincter, causing an inflammatory reaction of the larynx, oropharynx, and/or nasopharynx. [1] The incidence of LPR is estimated between 4%to 10% in the general population [2,3]
Both groups were homogeneous for gender and age and their clinical and demographical characteristics are described in Ocular evaluation demonstrated that patients with LPR showed ocular surface modifications when compared with healthy subjects (Table 1)
Thirty-two out of 50 (64%) of patients with LPR showed detectable pepsin values in tears, whereas in the control group lacrimal pepsin was undetectable in all subjects (p < 0.001)

Summary

Introduction

Laryngopharyngeal reflux (LPR) is a disease characterized by retrograde reflux of gastric and/or duodenal contents through the upper esophageal sphincter, causing an inflammatory reaction of the larynx, oropharynx, and/or nasopharynx. [1] The incidence of LPR is estimated between 4%to 10% in the general population [2,3]. Laryngopharyngeal reflux (LPR) is a disease characterized by retrograde reflux of gastric and/or duodenal contents through the upper esophageal sphincter, causing an inflammatory reaction of the larynx, oropharynx, and/or nasopharynx. Endoscopic evaluation in patients with LPR shows laryngeal edema and hyperemia associated with granulomatous and polypoid lesions [3]. These changes have been related to an increase of pepsin concentration in the upper respiratory tract structures in patients with LPR [7,8,9]. Pepsin is detectable only in the stomach, while in patients with LPR, the presence of pepsin was demonstrated in the

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