Salivary Pepsin versus Oesophageal PH Metry as a Diagnostic Test for Laryngopharyngeal Reflux Disease

Abstract

Abstract Background Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents (acid and enzymes such as pepsin) into the laryngopharynx leading to symptoms referable to the larynx/hypopharynx. Objective To evaluation of salivary pepsin as a non-invasive rapid test for diagnosis of laryngopharyngeal reflux versus oesophageal ph metry. Patients and Methods This was a prospective comparative study conducted on 50 subjects; to evaluate the salivary pepsin as a non-invasive rapid test for diagnosis of laryngo-pharyngeal reflux (LPR) versus oesophageal pH metry. Results The increase in age, laryngoscopic abnormality, and pH metry; had an independent effect on increasing salivary Pepsin; with significant statistical difference (p < 0.05 respectively). The increase in laryngoscopic abnormality; had an independent effect on increasing pH metry (% Time pH < 4); with significant statistical difference (p = 0.00002). The increase in pH metry (% Time pH < 4); had an independent effect on increasing the probability of LPR occurrence; with significant statistical difference (p < 0.005). Salivary Pepsin at a cutoff point (>5) predicted patients with LPR, with fair (77.9%) accuracy, sensitivity= 100% and specificity= 56% (p = 0.0001). PH metry (% Time pH < 4) at a cutoff point (>14) predicted patients with LPR, with good (87%) accuracy, sensitivity= 80% and specificity= 100% (p < 0.0001). Conclusion In this study we have shown that pepsin in saliva of patients with LPR is significantly higher than normal individuals, this may help as a diagnostic tool without using invasive methods for diagnosis of LPR.