title: Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease.
abstract: To determine the sensitivity of salivary pepsin compared with multichannel intraluminal impedance with pH testing (pH-MII), endoscopy, and gastroesophageal reflux disease (GERD) questionnaires.
  
  
  
  We prospectively recruited 50 children from Boston Children's Hospital who were undergoing pH-MII to evaluate for GERD. The patients completed 24-hour pH-MII testing, completed symptom and quality of life questionnaires, and provided a saliva specimen that was analyzed using the PepTest lateral flow test. A subset of patients also underwent bronchoscopy and esophagogastroduodenoscopy. Receiver operating characteristic curve analyses were performed to determine the sensitivity of salivary pepsin compared with each reference standard.
  
  
  
  Twenty-one of the 50 patients (42%) were salivary pepsin-positive, with a median salivary pepsin concentration of 10 ng/mL (IQR, 10-55 ng/mL). There was no significant difference in the distributions of acid, nonacid, total reflux episodes, full column reflux, or any other reflux variable in patients who were pepsin-positive compared with those who were pepsin-negative (P > .50). There was no significant correlation between the number of reflux episodes and pepsin concentration (P > .10). There was no positive relationship between salivary pepsin positivity, any extraesophageal symptoms or quality of life scores, or inflammation on bronchoscopy or esophagogastroduodenoscopy (P > .30).
  
  
  
  Salivary pepsin measurement has a low sensitivity for predicting pathological gastroesophageal reflux in children.
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA.
authors.forename: Fei
authors.initials: F
authors.lastname: Dy
authors.affiliation: Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA.
authors.forename: Janine
authors.initials: J
authors.lastname: Amirault
authors.affiliation: Clinical Research Center, Children's Hospital Boston, Boston, MA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mitchell
authors.affiliation: Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: Rachel.Rosen@childrens.harvard.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D004724:Endoscopy; D050782:Esophageal pH Monitoring / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D010434:Pepsin A / Q000378:metabolism*; D011446:Prospective Studies; D011788:Quality of Life; D012372:ROC Curve; D012463:Saliva / Q000378:metabolism*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D010434:Pepsin A
keywords: gastroesophageal reflux; impedance; pepsin