title: Detection of gastric pepsin in middle ear fluid of children with otitis media.
abstract: OBJECTIVE
  We sought to confirm the finding of pepsin/pepsinogen in the middle ear fluid of children with otitis media in a larger sample size using a sensitive and specific pepsin assay.
  
  
  METHODS
  We evaluated 152 children (225 ear samples) in a prospective study at a tertiary care children's hospital. The presence of pepsin in middle ear aspirates was determined using enzymatic assay.
  
  
  RESULTS
  Of the patients, 14.4 percent (22 of 152) had detectable pepsin activity in one or both of the ear samples with no pepsin activity detected in control serum. Average pepsin concentration in the samples was 96.6 +/- 170.8 ng/ml, ranging from 13 to 687 ng/ml. Pepsin concentration in the middle ear of children younger than 1.0 year was significantly higher than in older age groups.
  
  
  CONCLUSIONS
  Results indicate that pepsin/pepsinogen is present in the middle ears of children with otitis media, although not at the high rate previously reported. Gastric reflux may be one causative factor in the pathogenesis of otitis media.
authors.affiliation: Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. zhe@nemours.org
authors.forename: Zhaoping
authors.initials: Z
authors.lastname: He
authors.forename: Robert C
authors.initials: RC
authors.lastname: O'Reilly
authors.forename: Laura
authors.initials: L
authors.lastname: Bolling
authors.forename: Sam
authors.initials: S
authors.lastname: Soundar
authors.forename: Mansi
authors.initials: M
authors.lastname: Shah
authors.forename: Steven
authors.initials: S
authors.lastname: Cook
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schmidt
authors.forename: Esa
authors.initials: E
authors.lastname: Bloedon
authors.forename: Devendra I
authors.initials: DI
authors.lastname: Mehta
mesh_terms: D000367:Age Factors; D001249:Asthma / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005750:Gastric Juice / Q000201:enzymology*; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000201:enzymology*; D019152:Paracentesis; D010434:Pepsin A / Q000032:analysis* / Q000097:blood; D020116:Pepsinogen A / Q000032:analysis; D011446:Prospective Studies
chemical_list: D020116:Pepsinogen A; D010434:Pepsin A