Clinical relevance of salivary pepsin detection in diagnosing gastroesophageal reflux disease subtypes  

作　　者：Mengyu Zhang Tingting Wu Niandi Tan Songfeng Chen Qianjun Zhuang Yu Luo Yinglian Xiao 

机构地区：[1]Department of Gastroenterology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong,P.R.China

出　　处：《Gastroenterology Report》2023年第1期446-453,共8页胃肠病学报道（英文）

基　　金：supported by the Guangdong Natural Science Foundation[grant number 2023A1515010187];the Guangdong provincial and municipal Joint Fund[grant number 2022A1515111159];the China National Natural Science Foundation[grant numbers 82170577 and 81970479].

摘　　要：Background:Gastroesophageal reflux disease(GERD)is heterogeneous with a varied symptom spectrum and reflux profiles.Its definite diagnosis often requires invasive tools including endoscopy or reflux monitoring.The aim of this study was to investigate the clinical relevance of salivary pepsin detection as a non-invasive screening tool to diagnose GERD of different subtypes.Methods:A total of 77 patients with suspected GERD symptoms and 12 asymptomatic controls were analysed.All participants performed symptom evaluation,upper endoscopy,esophageal manometry,and 24-hour multichannel intraluminal impedance-dual pH probe monitoring.Saliva was self-collected across three different time points:at early fasting,postprandially,and at symptom occurrence.Salivary pepsin levels were measured via Peptest.The optimal threshold of salivary pepsin for diagnosing distal or proximal reflux was determined according to a receiver-operating characteristic curve.Results:The average salivary pepsin concentration of suspected GERD patients was significantly higher than that of controls(100.63[68.46,141.38]vs 67.90[31.60,115.06]ng/mL,P=0.044),although no difference was found among patients with different symptom spectrums.The distal reflux group had a higher average pepsin concentration than non-reflux patients(170.54[106.31,262.76]vs 91.13[63.35,127.63]ng/mL,P=0.043),while no difference was observed between the distal reflux group and the proximal reflux group.The optimal cut-off value of salivary pepsin concentration for diagnosing pathological distal reflux was 157.10 ng/mL,which was higher than that for diagnosing pathological proximal reflux(122.65 ng/mL).The salivary pepsin concentration was significantly correlated with distal and proximal reflux parameters.Conclusions:Salivary pepsin measurement can help in identifying true GERD with pathological distal reflux or proximal reflux,regardless of different symptom spectrums.A higher threshold should be applied for diagnosing distal reflux than for proximal reflux.

关 键 词：salivary pepsin gastroesophageal reflux disease laryngopharyngeal reflux screening and diagnosis 

分 类 号：R571[医药卫生—消化系统]