Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

• Published in: Clinical gastroenterology and hepatology Vol. 14; no. 4; pp. 535 - 542.e2
• Main Authors: Yadlapati, Rena, Adkins, Christopher, Jaiyeola, Diana-Marie, Lidder, Alcina K, Gawron, Andrew J, Tan, Bruce K, Shabeeb, Nadine, Price, Caroline P.E, Agrawal, Neelima, Ellenbogen, Michael, Smith, Stephanie S, Bove, Michiel, Pandolfino, John E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Adult; Diagnostic Tests, Routine - methods; Extraesophageal Reflux; Female; Gastroenterology and Hepatology; Gastroesophageal Reflux; Gastroesophageal Reflux - diagnosis; Humans; Hydrogen-Ion Concentration; Laryngoscopy; Male; Middle Aged; Oropharyngeal pH Testing; Oropharynx - chemistry; Pepsin A - analysis; Pilot Projects; Prospective Studies; Saliva - chemistry; Salivary Pepsin Analysis; Volunteers; Extraesophageal Reflux; Salivary Pepsin Analysis; laryngopharyngeal reflux; PPI; RSI; Gastroesophageal Reflux; LFD; proton pump inhibitor; LPR; GERD; lateral flow device; Oropharyngeal pH Testing; gastroesophageal reflux disease; reflux finding score; RFS; Reflux Symptom Index
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2015.11.017

Background & Aims It has been a challenge to confirm the association between laryngeal symptoms and physiological reflux disease. We examined the ability of oropharyngeal pH tests (with the Restech Dx-pH system) and salivary pepsin tests (with Peptest) to discriminate between asymptomatic volunteers (controls) and subjects with a combination of laryngeal and reflux symptoms (laryngeal ± reflux). Methods We performed a physician-blinded prospective cohort study of 59 subjects at a single academic institution. Adult volunteers were recruited and separated into 3 groups on the basis of GerdQ and Reflux Symptom Index scores: controls (n = 20), laryngeal symptoms (n = 20), or laryngeal + reflux symptoms (n = 19). Subjects underwent laryngoscopy and oropharyngeal pH tests and submitted saliva samples for analysis of pepsin concentration. Primary outcomes included abnormal acid exposure and composite (RYAN) score for oropharyngeal pH tests and abnormal mean salivary pepsin concentration that was based on normative data. Results Complete oropharyngeal pH data were available from 53 subjects and complete salivary pepsin data from 35 subjects. We did not observe any significant differences between groups in percent of time spent below pH 4.0, 5.0, 5.5, 6.0, or RYAN scores or percent of subjects with positive results from tests for salivary pepsin (53% vs 40% vs 75%; P  = .50, respectively). The laryngeal + reflux group had a significantly higher estimated mean concentration of salivary pepsin (117.9 ± 147.4 ng/mL) than the control group (32.4 ± 41.9 ng/mL) or laryngeal symptom group (7.5 ± 11.2 ng/mL) ( P  = .01 and P  = .04, respectively). Conclusions By using current normative thresholds, oropharyngeal pH testing and salivary pepsin analysis are not able to distinguish between healthy volunteers and subjects with a combination of laryngeal and reflux symptoms.