title: 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.
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.
authors.affiliation: Section of Gastroenterology, Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Potluri
authors.forename: Frank
authors.initials: F
authors.lastname: Friedenberg
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
authors.forename: Alan
authors.initials: A
authors.lastname: Chang
authors.forename: Robert
authors.initials: R
authors.lastname: MacNeal
authors.forename: Christopher
authors.initials: C
authors.lastname: Manus
authors.forename: Matthew Q
authors.initials: MQ
authors.lastname: Bromer
authors.forename: Aslam
authors.initials: A
authors.lastname: Malik
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fisher
authors.forename: Thomas
authors.initials: T
authors.lastname: Nugent
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Thangada
authors.forename: Friedrich
authors.initials: F
authors.lastname: Kueppers
authors.forename: Larry S
authors.initials: LS
authors.lastname: Miller
mesh_terms: D004945:Esophagoscopy; D004947:Esophagus / Q000737:chemistry; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010434:Pepsin A / Q000032:analysis*; D012463:Saliva / Q000737:chemistry*; D012680:Sensitivity and Specificity; D013183:Sputum / Q000737:chemistry*
chemical_list: D010434:Pepsin A