Utilidad clínica de la determinación de pepsina en saliva en pacientes con tos crónica asociada a refujo

Abstract

IntroductionChronic cough (CC) associated with reflux is very common in clinical practice, but it is not always easy to diagnose. The determination of pepsin in saliva is a novel, simple and non-invasive method for the study of reflux. ObjectiveTo analyze the diagnostic yield of the determination of pepsin in saliva in a patient with CC. MethodThis was a prospective study conducted in a consecutive cohort of patients with CC. Patients were diagnosed with cough associated with reflux according to 3criteria: 1) Presence of typical symptoms of gastroesophageal reflux disease (GERD), 2) Reflux Symptom Index> 13, Reflux Findings Score≥5 and 3) gastroesophageal transit, gastrointestinal endoscopy, and/or positive impedance pH monitoring. All patients underwent 2determinations of pepsin in saliva, using the Peptest®. ResultsWe included 99 patients, of which 64 (64.6%) were diagnosed with CC associated with reflux, 9 (14.1%) as the sole cause and 85.9% (55) associated with other diagnoses. Fifty-six had a positive Peptest®, with a sensitivity of 87.5%, specificity of 65.7%, and positive (PPV) and negative (NPV) predictive values of 82% and 74%, respectively. In patients without digestive symptoms, the PPV of pepsin was 64% and the NPV was 88%. ConclusionsReflux is an important cause of chronic cough and usually forms part of a multifactorial etiology. The determination of pepsin in saliva has a high sensitivity for reflux, but a low specificity that currently limits its routine use.