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Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease
Fei Dy1, Janine Amirault2, Paul D Mitchell3
1Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA.
Insights
Salivary pepsin testing shows low sensitivity for diagnosing gastroesophageal reflux disease (GERD) in children. This diagnostic method is not a reliable indicator of reflux when compared to established GERD evaluation techniques.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Test Evaluation
Background:
- Gastroesophageal reflux disease (GERD) is a common condition in children.
- Accurate diagnosis of GERD is crucial for effective management.
- Current diagnostic methods include multichannel intraluminal impedance with pH testing (pH-MII) and endoscopy.
Purpose of the Study:
- To assess the diagnostic sensitivity of salivary pepsin.
- To compare salivary pepsin performance against established GERD diagnostic standards.
Main Methods:
- Prospective recruitment of 50 children undergoing pH-MII for GERD evaluation.
- Collection of saliva for pepsin analysis using PepTest lateral flow.
- Comparison of salivary pepsin results with pH-MII, questionnaires, and endoscopic findings.
Main Results:
- 42% of patients tested positive for salivary pepsin.
- No significant differences in reflux parameters between pepsin-positive and negative groups.
- Salivary pepsin positivity did not correlate with symptoms, quality of life, or endoscopic inflammation.
Conclusions:
- Salivary pepsin measurement demonstrates low sensitivity in diagnosing pathological GERD in pediatric patients.
- Current evidence does not support salivary pepsin as a reliable standalone diagnostic tool for pediatric GERD.
Objectives:
To determine the sensitivity of salivary pepsin compared with multichannel intraluminal impedance with pH testing (pH-MII), endoscopy, and gastroesophageal reflux disease (GERD) questionnaires.
Study Design:
We prospectively recruited 50 children from Boston Children's Hospital who were undergoing pH-MII to evaluate for GERD. The patients completed 24-hour pH-MII testing, completed symptom and quality of life questionnaires, and provided a saliva specimen that was analyzed using the PepTest lateral flow test. A subset of patients also underwent bronchoscopy and esophagogastroduodenoscopy. Receiver operating characteristic curve analyses were performed to determine the sensitivity of salivary pepsin compared with each reference standard.
Results:
Twenty-one of the 50 patients (42%) were salivary pepsin-positive, with a median salivary pepsin concentration of 10 ng/mL (IQR, 10-55 ng/mL). There was no significant difference in the distributions of acid, nonacid, total reflux episodes, full column reflux, or any other reflux variable in patients who were pepsin-positive compared with those who were pepsin-negative (P > .50). There was no significant correlation between the number of reflux episodes and pepsin concentration (P > .10). There was no positive relationship between salivary pepsin positivity, any extraesophageal symptoms or quality of life scores, or inflammation on bronchoscopy or esophagogastroduodenoscopy (P > .30).
Conclusion:
Salivary pepsin measurement has a low sensitivity for predicting pathological gastroesophageal reflux in children.
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