title: Pepsin as a biomarker for laryngopharyngeal reflux in children with laryngomalacia.
abstract: Laryngomalacia is a common cause of newborn stridor. Laryngopharyngeal reflux (LPR) has been associated with laryngomalacia. Although pepsin, a component of LPR, has been associated with inflammatory diseases of the aerodigestive tract, its presence in the airways of laryngomalacia patients is unknown.
  
  
  
  Prospective case-control study comparing patients under age 3 years with laryngomalacia to children without laryngomalacia.
  
  
  
  Children less than 3 years old undergoing supraglottoplasty for laryngomalacia or surgery unrelated to the airway, without a history of laryngomalacia, reflux, or respiratory disease, were offered enrollment. Supraglottic lavage samples (3 mL) were obtained from all subjects. Two-millimeter arytenoid biopsies were collected from laryngomalacia patients. Pepsin Western blot and enzyme-linked immunosorbent assay were performed.
  
  
  
  Ten laryngomalacia and five control subjects were enrolled. Pepsin was detected in lavages of laryngomalacia patients (8/10) but absent in controls (0/5; P = .007). Pepsin was observed more frequently in lavages (8/10) than biopsies (4/10; P = .046) of laryngomalacia subjects. Higher median pepsin concentration was observed in laryngomalacia than control lavages (P = .025).
  
  
  
  Pepsin in supraglottic specimens demonstrated an association with laryngomalacia, supporting a role for refluxed pepsin in laryngomalacia. These data corroborate previous work implicating pepsin in inflammatory diseases of the upper airways. Further studies are warranted to investigate the contribution of pepsin to the pathophysiology of laryngomalacia.
  
  
  
  3b. Laryngoscope, 127:2413-2417, 2017.
authors.affiliation: Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.|Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Kendra
authors.initials: K
authors.lastname: Luebke
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Samuels
authors.affiliation: Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Chelius
authors.affiliation: Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.|Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Cecille G
authors.initials: CG
authors.lastname: Sulman
authors.affiliation: Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.|Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Michael E
authors.initials: ME
authors.lastname: McCormick
authors.affiliation: Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.|Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Kerschner
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
authors.affiliation: Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, U.S.A.|Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Chun
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D015153:Blotting, Western; D016022:Case-Control Studies; D004591:Electrophoresis, Polyacrylamide Gel; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D007820:Laryngeal Mucosa / Q000378:metabolism*; D055092:Laryngomalacia / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D008297:Male; D010434:Pepsin A / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D010434:Pepsin A
keywords: Laryngomalacia; laryngopharyngeal reflux; pepsin