title: Investigation of pepsin in tears of children with laryngopharyngeal reflux disease.
abstract: OBJECTIVE
  Numerous investigations postulated that laryngopharyngeal reflux (LPR) is implicated in the pathogenesis of various upper airway inflammatory diseases as sinusitis or dacryostenosis. The presence of pepsin in tears might be confirmed the presuntive hypothesis of the arrival in the nasolacrimal ducts and precorneal tears film through the laryngopharyngeal reflux of either gastric acid or stomach secretions (pepsin) with inflammatory potentialities. The aim of this preliminary study was to identify the presence or absence of pepsin in the tears collected from children with a high suspicion of LPR who underwent 24-h pH (MII-pH) monitoring to confirm the disease.
  
  
  METHODS
  This study enrolled 20 patients suffering from symptoms of laryngopharyngeal reflux that underwent 24-h multichannel intraluminal impedance (MII)-pH monitoring to confirm the disease. The findings of the study group were compared with those of a control group of patients with negative pH monitoring. The quantitative analysis of human pepsin concentration in the tear samples was performed by ELISA method in both groups.
  
  
  RESULTS
  Four children (20%) of the study group showed pepsin in the tears. All of the subjects belonging to the control group were negative for its presence. No difference differences in the total number of reflux episodes and the number of weakly basic reflux in the pepsin positive patients vs. pepsin negative children were present.
  
  
  CONCLUSIONS
  20% of the children with diagnosed LPR showed pepsin in the tears. Our specific investigation might provide information regarding sinusitis or dacryostenosis.
authors.affiliation: Organi di Senso Department, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: giannicolaiannella@hotmail.it.
authors.forename: Giannicola
authors.initials: G
authors.lastname: Iannella
authors.affiliation: Department of Pediatrics, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: giovanni.dinardo@uniroma1.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.affiliation: Organi di Senso Department, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: rocco.plateroti@uniroma1.it.
authors.forename: Rocco
authors.initials: R
authors.lastname: Plateroti
authors.affiliation: Department of Pediatrics, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: paolo.rossi@uniroma1.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.affiliation: Organi di Senso Department, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: andrea.plateroti@gmail.com.
authors.forename: Andrea Maria
authors.initials: AM
authors.lastname: Plateroti
authors.affiliation: Department of General and specialized surgery Paride Stefanini, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: paola.mariani@uniroma1.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Mariani
authors.affiliation: Organi di Senso Department, University "La Sapienza", Viale del Policlinico, 151, 00161 Rome, Italy. Electronic address: giuseppemagliuloorl@yahoo.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magliulo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D004797:Enzyme-Linked Immunosorbent Assay; D005136:Eye Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000378:metabolism*; D008297:Male; D008991:Monitoring, Physiologic; D010434:Pepsin A / Q000378:metabolism*; D011446:Prospective Studies; D013666:Tears / Q000378:metabolism*
chemical_list: D005136:Eye Proteins; C042434:tear proteins; D010434:Pepsin A
keywords: Gastroesophageal reflux; Laryngopharyngeal reflux; Pediatric; Pepsin; Tears; pH-metry