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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

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Abstract

The purpose of this study was to determine whether measurement of salivary/sputum pepsin could be used as a surrogate marker for detecting gastroesophageal reflux using 24-hr esophageal pH monitoring as the gold standard. Patients with gastroesophageal reflux symptoms underwent simultaneous 24-hr esophageal pH monitoring and collection of saliva and sputum samples for pepsin measurement using a recently developed assay. In all, 16 patients provided 19 positive (10.6%) and 161 negative pepsin assays. The mean pH values for the positive pepsin samples were lower then the negative samples at both the proximal [5.34 (95% CI, 4.94–5.75) vs 6.12 (95% CI, 6.03–6.20; P <0.01)] and distal [4.97 (95% CI, 4.61–5.33) vs 6.03 (95% CI, 5.92–6.15; P < 0.01)] pH probes. Proximal esophageal reflux was not detected in patients who had a negative pepsin assay (N = 12); in contrast, proximal esophageal reflux was documented in three of four patients with a positive assay. In conclusion, detection of pepsin in the saliva and/or sputum may provide a noninvasive method to test for the proximal reflux of gastric contents.

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REFERENCES

  1. Larrain A, Carrasco E, Galleguillos F, Sepulveda R, Pope CE: Medical and surgical treatment of non-allergic asthma associated with gastroesophagal reflux. Chest 99:1330–1335, 1991

    Google Scholar 

  2. Belsey R: The pulmonary complications of oesophageal disease. Br J Dis Chest 54:342, 1960

    Google Scholar 

  3. Mansfield LE, Stein MR: Gastroesophageal reflux and asthma: a possible reflex mechanism. Ann Allergy 41:224, 1978

    Google Scholar 

  4. Bretza J, Novey HS: GE reflux and asthma. West J Med 131:320, 1979

    Google Scholar 

  5. Corwin RW, Irwin RS: The lipid-laden alveolar macrophage as a marker of aspiration in parenchymal lung disease. Am Rev Respir Dis 132:576, 1985

    Google Scholar 

  6. Nussbaum E, Maggi JC, Mathis R, Galant SP: Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children. Pediatr 110:190, 1987

    Google Scholar 

  7. Chernow B, Johnson LF, Janowitz WR, Castell DO: Pulmonary aspiration as a consequence of Gastroesophageal reflux: A diagnostic approach. Dig Dis Sci 24:839–844, 1979

    Google Scholar 

  8. Ghaed N, Stein M: Assessment of a technique for scintigraphic monitoring of pulmonary aspiration of gastric contents in asthmatics with gastroesophageal reflux. Ann Allergy 42:306, 1979

    Google Scholar 

  9. Reich SB, Earley WC, Ravin TH, Goodman M, Spector S, Stein MR: Evaluation of gastropulmonary aspiration by a radioactive technique. J Nucl Med 18:1079, 1977

    Google Scholar 

  10. Herbst JJ, Minton SD, Book LS: Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr 95:763, 1979

    Google Scholar 

  11. Pellegrini CA, De Meester TR, Johnson LF, Skinner DB: Gastroesophageal reflux and pulmonary aspiration: incidence, functional abnormality, and results of surgical therapy. Surgery 86:110, 1979

    Google Scholar 

  12. Sontag SJ, Schnell TG, Miller Q, Khandelwal S, O'Connell S, Chejfec G, Greenlee H, Seidel UJ, Brand L: Prevalence of oesophagitis in asthmatics. Gut 33(7):872–876, 1992

    Google Scholar 

  13. Davis RS, Larsen GL, Grunstein MM: Respiratory response to intraesophageal acid infusion in asthmatic children during sleep. J Allergy Clin Immunol 72:393, 1983

    Google Scholar 

  14. O'Connell S: Asthmatics have a high prevalence of reflux symptoms regardless of the use of bronchodilators. Gastroenterology 98(2): A97, 1990

    Google Scholar 

  15. Perrin-Fayolle MM, Bel A, Kofman J, Harf R, Montagnon B, Pacheco Y, Daudet J, Nesmoz J, Perpoint B: Asthma and gastroesophageal reflux. Results of a survey of over 150 cases. Poulmon Coeur 36:225, 1980

    Google Scholar 

  16. Varis KS: Peptic Cells. Prog Clin Biol Res 173:177–184, 1985

    Google Scholar 

  17. Tobey NA, Hosseini SS, Caymaz-Bor C, Wyatt HR, Orlando GS, Orlando RC: The role of pepsin in acid injury to esophageal epithelium. Am J Gastroenterol 96:3062–3070, 2001

    Google Scholar 

  18. Derosa J, Marcinkiewicz M, Sarosiek J, Edmunds M, McCallum RW: Modulatory impact of acid and pepsin on esophageal hydrophobicity in humans. Am J Gastroenterol 90:2020–2024, 1995

    Google Scholar 

  19. Krishnan U, Mitchell JD, Messina I, Day AS, Bohane TD: Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr 35:303–308, 2002

    Google Scholar 

  20. Metheny NA, Chang YH, Ye JS, Edwards SJ, Defer J, Dahms TE, Stewart BJ, Stone KS, Clouse RE: Pepsin as a marker of pulmonary aspiration. Am J Crit Care 11:150–154, 2002

    Google Scholar 

  21. Badellino MM. Buckman RF, Malaspina PJ, Eynon CA, O'Brien GM, Kueppers F: Detection of pulmonary aspiration of gastric contents in an animal model by assay of peptic activity in bronchoalveolar fluid. Crit Care Med 24(11);1881–1885, 1996

    Google Scholar 

  22. Kueppers F, Miller LS, Karras D, Ufberg J, Bushra J: Pepsin Determination in Aspiration and Reflux Disease (GERD). Chest 122:A57, 2002

    Google Scholar 

  23. Maldonado A, Diederich L, Castell DO, Gideon RM, Katz PO: Laryngopharyngeal reflux identified using a new catheter design: defining normal values and excluding artifacts. Laryngoscope 11:349–355, 2003

    Google Scholar 

  24. Vaezi MF, Shay SS: New techniques in measuring nonacidic esophageal reflux. Semin Thorac Cardiovasc Surg 13:255–264, 2001

    Google Scholar 

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Potluri, S., Friedenberg, F., Parkman, H.P. et al. 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, 1813–1817 (2003). https://doi.org/10.1023/A:1025467600662

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  • DOI: https://doi.org/10.1023/A:1025467600662

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