Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review

  title={Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review},
  author={Christian Calvo-Henr{\'i}quez and Christian Calvo-Henr{\'i}quez and Alberto Ruano-Ravi{\~n}a and Pedro Vaamonde and Gabriel Mart{\'i}nez-Capoccioni and Carlos Martin-Martin},
  journal={Otolaryngology–Head and Neck Surgery},
  pages={385 - 391}
Objective Laryngopharyngeal reflux (LPR) is a common illness of otolaryngology visits. Over the past few years, pepsin has become a promising marker of LPR. The objective of the present research is to analyze the existing literature using pepsin as a diagnostic tool of LPR through a systematic review. Data Sources PubMed (Medline), Trip Database, Cochrane Library, EMBASE, SUMsearch, and Web of Science. Review Methods The outcome assessed was the presence of pepsin in LPR patients. We included… 

Figures and Tables from this paper

Salivary peptest for laryngopharyngeal reflux and gastroesophageal reflux disease

Peptest shows moderate diagnostic value for LPR and GERD, and more studies with standard protocols should be done to verify its usefulness.

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

  • J. LechienL. Akst M. Vaezi
  • Medicine
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2019
The important heterogeneity across studies in LPR diagnosis continues to make it difficult to summarize a single body of thought, and LPR treatment should evolve to a more personalized regimen according to individual patient characteristics.

Pepsin in Saliva as a Diagnostic Marker for Gastroesophageal Reflux Disease: A Meta-Analysis

It was showed that pepsin in saliva has moderate diagnostic value for GERD, and is not as helpful as previously thought.

Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018

Diagnosis remains controversial despite improvement in impedance and availability of pepsin detection in daily practice, and the addition of alginate or magaldrate to proton pump inhibitors should be considered.

In Reference to Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

According to the lack of evidence about the Peptest’s validity, future researchers who study epidemiological characteristics of the PePTest should include patients with a demonstrated LPR diagnosis, and should consider the diet during the testing period for LPR patients and healthy controls.

Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?

Although a single detection of salivary pepsin in the morning is more economical, the sensitivity is too low, and it is necessary to detect it multiple times a day.

Detection of Pepsin in Oral Secretions of Infants with and without Laryngomalacia

Pepsin in saliva appears to be associated with laryngomalacia, suggesting a role for salivary pepsin as a noninvasive marker of LPR in patients with laryngeal reflux, and future studies will determine the utility of this test in larygomalacia.

Is the pepsin immunohistochemical staining of laryngeal lesions an available way for diagnosing laryngopharyngeal reflux

The sensitivity of pepsin IHC staining in laryngeal lesions for diagnosing LPR is satisfactory, and the existence of false negative of MII-pH may be the main reason for the low specificity.

Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux.

Salivary pepsin testing combined with waking, 1’h and 2 h after breakfast and lunch, and 1”h after dinner has almost the same diagnostic value as MTPSPT, and testing at these time points can be an effective method for diagnosing LPR.



Investigation of pepsin in tears of children with laryngopharyngeal reflux disease.

Correlation of pepsin-measured laryngopharyngeal reflux disease with symptoms and signs

  • Lu WangXiong Liu Xiangping Li
  • Medicine
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2010

Hypopharyngeal pepsin and Sep70 as diagnostic markers of laryngopharyngeal reflux: preliminary study

Depletion of Sep70 with the presence of pepsin in the hypopharynx may indicate cellular injury in laryngopharynX due to constant proximal reflux, however, the normative data for these markers have to be validated.

Diagnosis of laryngopharyngeal reflux among globus patients.

Gastroesophageal Reflux Disease and the Larynx

  • M. Vaezi
  • Medicine
    Journal of clinical gastroenterology
  • 2003
Experimental evidence highlights the importance of acidic refluxates that contain pepsin and/or bile acids; however, many patients with laryngeal signs suggestive of GERD do not respond to aggressive acid suppression, and a multidisciplinary approach is often required in the optimum treatment of these patients.

Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease

In patients with symptoms suggestive of GORD, salivary pepsin testing may complement questionnaires to assist office-based diagnosis and lessen the use of unnecessary antireflux therapy and the need for further invasive and expensive diagnostic methods.

Validity and reliability of the reflux symptom index (RSI).

Objective Detection of Esophagopharyngeal Reflux in Patients With Hoarseness and Endoscopic Signs of Laryngeal Inflammation

It is proposed that patients diagnosed with reflux-related hoarseness and healthy controls undergoing simultaneous impedance pH, Dx-pH monitoring, and saliva pepsin sampling are more likely to benefit from further intense antireflux therapy.

High Economic Burden of Caring for Patients With Suspected Extraesophageal Reflux

In this cohort, the cost for initial year's evaluation and treatment of extraesophageal reflux symptoms was quintuple that of typical GERD.