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Erschienen in: European Archives of Oto-Rhino-Laryngology 3/2018

13.12.2017 | Review Article

Pepsin in saliva as a diagnostic biomarker in laryngopharyngeal reflux: a meta-analysis

verfasst von: Jing Wang, Yu Zhao, Jianjun Ren, Yang Xu

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 3/2018

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Abstract

Objective

Pepsin in saliva has been proposed as a biomarker for the diagnosis of laryngopharyngeal reflux (LPR), but the results remain controversial. We assessed the diagnostic value of pepsin in saliva for LPR.

Methods

PubMed, Embase, and Web of Science were searched for studies in English that evaluated the utility of pepsin in saliva in the diagnosis of LPR, published up to 15 March 2017. We used Stata 12.0 to summarize the diagnostic indexes for the meta-analysis.

Results

Eleven eligible studies met the inclusion criteria. After the meta-analysis of included studies, the pooled sensitivity and specificity were 64% [95% confidence interval (CI) 43–80%] and 68% (95% CI 55–78%), respectively; the positive (PLR) and negative (NLR) likelihood ratios were 2.0 (95% CI 1.4–2.9) and 0.54 (95% CI 0.33–0.87), respectively; the diagnostic odds ratio (DOR) was 4 (95% CI 2–8); and the area under the curve (AUC) was 0.71 (95% CI 0.67–0.75).

Conclusion

Pepsin in saliva has moderate value in the diagnosis of LPR. The cutoff value used could affect the diagnostic value. Therefore, further investigations are required to find the optimal method to detect salivary pepsin in diagnosing LPR.
Literatur
1.
Zurück zum Zitat Formánek M, Zeleník K, Komínek P, Matoušek P (2015) Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest. Int J Pediatr Otorhinolaryngol 79(5):677–679CrossRefPubMed Formánek M, Zeleník K, Komínek P, Matoušek P (2015) Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest. Int J Pediatr Otorhinolaryngol 79(5):677–679CrossRefPubMed
2.
Zurück zum Zitat Zhu GC, Gao X, Wang ZG, Hu ZW, Zhang CC, Lai YG, Ji F, Wu JM (2014) Experimental study for the mechanism of gastroesophageal-reflux-associated asthma. Dis Esophagus 27(4):318–324CrossRefPubMed Zhu GC, Gao X, Wang ZG, Hu ZW, Zhang CC, Lai YG, Ji F, Wu JM (2014) Experimental study for the mechanism of gastroesophageal-reflux-associated asthma. Dis Esophagus 27(4):318–324CrossRefPubMed
3.
Zurück zum Zitat Decalmer S, Stovold R, Houghton LA, Pearson J, Ward C, Kelsall A, Jones H, McGuinness K, Woodcock A, Smith JA (2012) Chronic cough: relationship between microaspiration, gastroesophageal reflux, and cough frequency. Chest 142(4):958–964CrossRefPubMed Decalmer S, Stovold R, Houghton LA, Pearson J, Ward C, Kelsall A, Jones H, McGuinness K, Woodcock A, Smith JA (2012) Chronic cough: relationship between microaspiration, gastroesophageal reflux, and cough frequency. Chest 142(4):958–964CrossRefPubMed
4.
Zurück zum Zitat Saritas YE, Vaezi MF (2012) Extraesophageal manifestations of gastroesophageal reflux disease: cough, asthma, laryngitis, chest pain. Swiss Med Wkly 142:w13544 Saritas YE, Vaezi MF (2012) Extraesophageal manifestations of gastroesophageal reflux disease: cough, asthma, laryngitis, chest pain. Swiss Med Wkly 142:w13544
5.
Zurück zum Zitat Maldhure S, Chandrasekharan R, Dutta AK, Chacko A, Kurien M (2016) Role of PH monitoring in laryngopharyngeal reflux patients with voice disorders. Iran J Otorhinolaryngol 28(89):377–383PubMedPubMedCentral Maldhure S, Chandrasekharan R, Dutta AK, Chacko A, Kurien M (2016) Role of PH monitoring in laryngopharyngeal reflux patients with voice disorders. Iran J Otorhinolaryngol 28(89):377–383PubMedPubMedCentral
6.
Zurück zum Zitat Ford CN (2005) Evaluation and management of laryngopharyngeal reflux. JAMA 294(12):1534–1540CrossRefPubMed Ford CN (2005) Evaluation and management of laryngopharyngeal reflux. JAMA 294(12):1534–1540CrossRefPubMed
7.
Zurück zum Zitat Bytzer P, Jones R, Vakil N, Junghard O, Lind T, Wernersson B, Dent J (2012) Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 10(12):1360–1366CrossRefPubMed Bytzer P, Jones R, Vakil N, Junghard O, Lind T, Wernersson B, Dent J (2012) Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 10(12):1360–1366CrossRefPubMed
8.
Zurück zum Zitat Doğru M, Kuran G, Haytoğlu S, Dengiz R, Arıkan OK (2015) Role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion. J Int Adv Otol 11(1):66–71CrossRefPubMed Doğru M, Kuran G, Haytoğlu S, Dengiz R, Arıkan OK (2015) Role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion. J Int Adv Otol 11(1):66–71CrossRefPubMed
9.
Zurück zum Zitat Iannella G, Di NG, Plateroti R, Rossi P, Plateroti AM, Mariani P, Magliulo G (2015) Investigation of pepsin in tears of children with laryngopharyngeal reflux disease. Int J Pediatr Otorhinolaryngol 79(12):2312–2315CrossRefPubMed Iannella G, Di NG, Plateroti R, Rossi P, Plateroti AM, Mariani P, Magliulo G (2015) Investigation of pepsin in tears of children with laryngopharyngeal reflux disease. Int J Pediatr Otorhinolaryngol 79(12):2312–2315CrossRefPubMed
10.
Zurück zum Zitat Sereg-Bahar M, Jerin A, Jansa R, Stabuc B, Hocevar-Boltezar I (2015) Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux—a prospective comparative study. Clin Otolaryngol 40(3):234–239CrossRefPubMed Sereg-Bahar M, Jerin A, Jansa R, Stabuc B, Hocevar-Boltezar I (2015) Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux—a prospective comparative study. Clin Otolaryngol 40(3):234–239CrossRefPubMed
11.
Zurück zum Zitat Samuels TL, Johnston N (2010) Pepsin as a marker of extraesophageal reflux. Ann Otol Rhinol Laryngol 119(3):203–208CrossRefPubMed Samuels TL, Johnston N (2010) Pepsin as a marker of extraesophageal reflux. Ann Otol Rhinol Laryngol 119(3):203–208CrossRefPubMed
12.
Zurück zum Zitat Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536CrossRefPubMed Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536CrossRefPubMed
13.
Zurück zum Zitat Fortunato JE, D’Agostino RB, Lively MO (2017) Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24-hour esophageal impedance/pH monitoring in pediatric patients. Neurogastroenterol Motil 29(2) Fortunato JE, D’Agostino RB, Lively MO (2017) Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24-hour esophageal impedance/pH monitoring in pediatric patients. Neurogastroenterol Motil 29(2)
14.
Zurück zum Zitat Dy F, Amirault J, Mitchell PD, Rosen R (2016) Salivary pepsin lacks sensitivity as a diagnostic tool to evaluate extraesophageal reflux disease. J Pediatr 177(:53–58CrossRefPubMedPubMedCentral Dy F, Amirault J, Mitchell PD, Rosen R (2016) Salivary pepsin lacks sensitivity as a diagnostic tool to evaluate extraesophageal reflux disease. J Pediatr 177(:53–58CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Yadlapati R, Adkins C, Jaiyeola DM, Lidder AK, Gawron AJ, Tan BK, Shabeeb N, Price CP, Agrawal N, Ellenbogen M, Smith SS, Bove M, Pandolfino JE (2016) Abilities of oropharyngeal pH tests and salivary pepsin analysis to discriminate between asymptomatic volunteers and subjects with symptoms of laryngeal irritation. Clin Gastroenterol Hepatol 14(4):535–542.e2CrossRefPubMed Yadlapati R, Adkins C, Jaiyeola DM, Lidder AK, Gawron AJ, Tan BK, Shabeeb N, Price CP, Agrawal N, Ellenbogen M, Smith SS, Bove M, Pandolfino JE (2016) Abilities of oropharyngeal pH tests and salivary pepsin analysis to discriminate between asymptomatic volunteers and subjects with symptoms of laryngeal irritation. Clin Gastroenterol Hepatol 14(4):535–542.e2CrossRefPubMed
16.
Zurück zum Zitat Hayat JO, Gabieta-Somnez S, Yazaki E, Kang JY, Woodcock A, Dettmar P, Mabary J, Knowles CH, Sifrim D (2015) Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease. Gut 64(3):373–380CrossRefPubMed Hayat JO, Gabieta-Somnez S, Yazaki E, Kang JY, Woodcock A, Dettmar P, Mabary J, Knowles CH, Sifrim D (2015) Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease. Gut 64(3):373–380CrossRefPubMed
17.
Zurück zum Zitat Ocak E, Kubat G, Yorulmaz İ (2015) Immunoserologic pepsin detection in the saliva as a non-invasive rapid diagnostic test for laryngopharyngeal reflux. Balkan Med J 32(1):46–50CrossRefPubMedPubMedCentral Ocak E, Kubat G, Yorulmaz İ (2015) Immunoserologic pepsin detection in the saliva as a non-invasive rapid diagnostic test for laryngopharyngeal reflux. Balkan Med J 32(1):46–50CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Spyridoulias A, Lillie S, Vyas A, Fowler SJ (2015) Detecting laryngopharyngeal reflux in patients with upper airways symptoms: symptoms, signs or salivary pepsin. Respir Med 109(8):963–969CrossRefPubMed Spyridoulias A, Lillie S, Vyas A, Fowler SJ (2015) Detecting laryngopharyngeal reflux in patients with upper airways symptoms: symptoms, signs or salivary pepsin. Respir Med 109(8):963–969CrossRefPubMed
19.
Zurück zum Zitat Hayat JO, Yazaki E, Moore AT, Hicklin L, Dettmar P, Kang JY, Sifrim D (2014) Objective detection of esophagopharyngeal reflux in patients with hoarseness and endoscopic signs of laryngeal inflammation. J Clin Gastroenterol 48(4):318–327CrossRefPubMed Hayat JO, Yazaki E, Moore AT, Hicklin L, Dettmar P, Kang JY, Sifrim D (2014) Objective detection of esophagopharyngeal reflux in patients with hoarseness and endoscopic signs of laryngeal inflammation. J Clin Gastroenterol 48(4):318–327CrossRefPubMed
20.
Zurück zum Zitat Saritas YE, Hong SK, Strugala V, Slaughter JC, Goutte M, Garrett CG, Dettmar PW, Vaezi MF (2012) Rapid salivary pepsin test: blinded assessment of test performance in gastroesophageal reflux disease. Laryngoscope 122(6):1312–1316CrossRef Saritas YE, Hong SK, Strugala V, Slaughter JC, Goutte M, Garrett CG, Dettmar PW, Vaezi MF (2012) Rapid salivary pepsin test: blinded assessment of test performance in gastroesophageal reflux disease. Laryngoscope 122(6):1312–1316CrossRef
21.
Zurück zum Zitat Kim TH, Lee KJ, Yeo M, Kim DK, Cho SW (2008) Pepsin detection in the sputum/saliva for the diagnosis of gastroesophageal reflux disease in patients with clinically suspected atypical gastroesophageal reflux disease symptoms. Digestion 77(3–4):201–206CrossRefPubMed Kim TH, Lee KJ, Yeo M, Kim DK, Cho SW (2008) Pepsin detection in the sputum/saliva for the diagnosis of gastroesophageal reflux disease in patients with clinically suspected atypical gastroesophageal reflux disease symptoms. Digestion 77(3–4):201–206CrossRefPubMed
22.
Zurück zum Zitat Printza A, Speletas M, Triaridis S, Wilson J (2007) Is pepsin detected in the saliva of patients who experience pharyngeal reflux. Hippokratia 11(3):145–149PubMedPubMedCentral Printza A, Speletas M, Triaridis S, Wilson J (2007) Is pepsin detected in the saliva of patients who experience pharyngeal reflux. Hippokratia 11(3):145–149PubMedPubMedCentral
23.
Zurück zum Zitat Potluri S, Friedenberg F, Parkman HP, Chang A, MacNeal R, Manus C, Bromer MQ, Malik A, Fisher RS, Nugent T, Thangada VK, Kueppers F, Miller LS (2003) Comparison of a salivary/sputum pepsin assay with 24-hour esophageal pH monitoring for detection of gastric reflux into the proximal esophagus, oropharynx, and lung. Dig Dis Sci 48(9):1813–1817CrossRefPubMed Potluri S, Friedenberg F, Parkman HP, Chang A, MacNeal R, Manus C, Bromer MQ, Malik A, Fisher RS, Nugent T, Thangada VK, Kueppers F, Miller LS (2003) Comparison of a salivary/sputum pepsin assay with 24-hour esophageal pH monitoring for detection of gastric reflux into the proximal esophagus, oropharynx, and lung. Dig Dis Sci 48(9):1813–1817CrossRefPubMed
24.
Zurück zum Zitat Kim SI, Kwon OE, Na SY, Lee YC, Park JM, Eun YG (2017) Association between 24-hour combined multichannel intraluminal impedance-pH monitoring and symptoms or quality of life in patients with laryngopharyngeal reflux. Clin Otolaryngol 42(3):584–591CrossRefPubMed Kim SI, Kwon OE, Na SY, Lee YC, Park JM, Eun YG (2017) Association between 24-hour combined multichannel intraluminal impedance-pH monitoring and symptoms or quality of life in patients with laryngopharyngeal reflux. Clin Otolaryngol 42(3):584–591CrossRefPubMed
25.
Zurück zum Zitat Na SY, Kwon OE, Lee YC, Eun YG (2016) Optimal timing of saliva collection to detect pepsin in patients with laryngopharyngeal reflux. Laryngoscope 126(12):2770–2773CrossRefPubMed Na SY, Kwon OE, Lee YC, Eun YG (2016) Optimal timing of saliva collection to detect pepsin in patients with laryngopharyngeal reflux. Laryngoscope 126(12):2770–2773CrossRefPubMed
Metadaten
Titel
Pepsin in saliva as a diagnostic biomarker in laryngopharyngeal reflux: a meta-analysis
verfasst von
Jing Wang
Yu Zhao
Jianjun Ren
Yang Xu
Publikationsdatum
13.12.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 3/2018
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-017-4845-8

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