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Updated: Jul 9, 2025

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Laryngopharyngeal Reflux Scoring in a Pediatric Population
Ivan Abičić1,2, Marina Čović3, Milorad Zjalić4
1Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
Insights
Pediatric laryngopharyngeal reflux (LPR) may involve pepsin in tonsils. While not statistically significant, higher reflux scores were seen in children with pepsin in their palatine tonsils, suggesting a potential link.
Area of Science:
- Otolaryngology
- Gastroenterology
- Pediatric Medicine
Background:
- Laryngopharyngeal reflux (LPR) is increasingly diagnosed in children.
- Current LPR diagnosis relies on history and tools like the Reflux Finding Score (RFS) and Reflux Symptom Index (RSI).
- Pepsin's role in LPR and tonsil hypertrophy is under investigation.
Purpose of the Study:
- To explore the correlation between LPR manifestations and pepsin presence in pediatric saliva and palatine tonsils.
- To assess pepsin's association with laryngeal and pharyngeal symptoms in children.
Main Methods:
- Investigated pediatric patients using questionnaires (RSI, RFS).
- Detected salivary pepsin via Western blot.
- Assessed palatine tonsil pepsin presence using immunohistochemistry (IHC).
Main Results:
- No significant difference in RFS and RSI between IHC-positive and IHC-negative groups.
- Median RSI and RFS values trended higher in the IHC-positive group.
- Suggests a potential association between elevated reflux scores and tonsillar pepsin.
Conclusions:
- Pepsin presence in palatine tonsils may correlate with LPR symptom severity in children.
- Further research is needed to clarify the clinical significance of tonsillar pepsin in pediatric LPR.
Abstract:
In recent years, the prevalence of laryngopharyngeal reflux has risen, especially among pediatric patients. The diagnosis of laryngopharyngeal reflux relies on patient history and clinical assessment using the Reflux Finding Score and Reflux Symptom Index as crucial diagnostic tools. Some studies have proposed a link between pepsin and laryngopharyngeal reflux, potentially triggering palatine tonsil hypertrophy. Our study aimed to investigate the correlation between laryngeal and pharyngeal manifestations of laryngopharyngeal reflux through two questionnaires and the presence of pepsin in saliva and palatine tonsils in a pediatric population. Pepsin in saliva was detected using a Western blot method, while immunohistochemistry assessed its presence in palatine tonsils. Although no statistically significant differences in Reflux Finding Score and Reflux Symptom Index were found between the immunohistochemistry-positive (IHC-positive) and immunohistochemistry-negative (IHC-negative) groups, median reflux symptom index and Reflux Finding Score values consistently trended higher in the IHC-positive group. This suggests a potential connection between elevated index values and pepsin presence in tonsillar tissue. Further investigations are essential to fully comprehend the clinical implications of these findings.
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