title: Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication.
abstract: BACKGROUND
  Some patients with gastroesophageal reflux disease (GERD) suffer from laryngopharyngeal reflux (LPR). There is no reliable diagnostic test for LPR as there is for GERD. We hypothesized that detection of pepsin (a molecule only made in the stomach) in laryngeal epithelium or sputum should provide evidence for reflux of gastric contents to the larynx, and be diagnostic of LPR. We tested this hypothesis in a prospective study in patients with LPR symptoms undergoing antireflux surgery (ARS).
  
  
  METHODS
  Nine patients undergoing ARS for LPR symptoms were studied pre- and postoperatively using a clinical symptom questionnaire, laryngoscopy, 24-h pH monitoring, biopsy of posterior laryngeal mucosa, and sputum collection for pepsin Western blot assay.
  
  
  RESULTS
  The primary presenting LPR symptom was hoarseness in six, cough in two, and globus sensation in one patient. Pepsin was detected in the laryngeal mucosa in eight of nine patients preoperatively. There was correlation between biopsy and sputum (+/+ or -/-) in four of five patients, both analyzed preoperatively. Postoperatively, pH monitoring improved in all but one patient and normalized in five of eight patients. Eight of nine patients reported improvement in their primary LPR symptom (six good, two mild). Only one patient (who had negative preoperative pepsin) reported no response to treatment of the primary LPR symptom. Postoperatively, pepsin was detected in only one patient.
  
  
  CONCLUSIONS
  Pepsin is often found on laryngeal epithelial biopsy and in sputum of patients with pH-test-proven GERD and symptoms of LPR. ARS improves symptoms and clears pepsin from the upper airway. Detection of pepsin improves diagnostic accuracy in patients with LPR.
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, 98195, Seattle, WA, USA. ewassena@uw.edu
authors.forename: Eelco
authors.initials: E
authors.lastname: Wassenaar
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
authors.forename: Albert
authors.initials: A
authors.lastname: Merati
authors.forename: Martin
authors.initials: M
authors.lastname: Montenovo
authors.forename: Rebecca
authors.initials: R
authors.lastname: Petersen
authors.forename: Roger
authors.initials: R
authors.lastname: Tatum
authors.forename: Carlos
authors.initials: C
authors.lastname: Pellegrini
authors.forename: Brant
authors.initials: B
authors.lastname: Oelschlager
mesh_terms: D000328:Adult; D000368:Aged; D015153:Blotting, Western; D003371:Cough / Q000209:etiology; D005260:Female; D018662:Fundoplication; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D010434:Pepsin A / Q000378:metabolism*
chemical_list: D010434:Pepsin A