Pepsin in secretion from the upper respiratory tract as a marker of extraesophageal reflux in children

Czech version

Authors: T. Strachan ^1,2; J. Melter ²; A. Barabasová ²; M. Miškovská ²; P. Ferenc ²; J. Fábry ²; Peter Bánovčin ¹
Authors‘ workplace: Klinika detí a dorastu Jesseniovej lekárskej fakulty Univerzity Komenského v Bratislave a Univerzitnej nemocnice, Martin ¹; Šrobárov ústav detskej tuberkulózy a respiračných chorôb, n. o., a Klinika detskej TBC a respiračných chorôb JLF UK, Dolný Smokovec ²
Published in: Čes-slov Pediat 2017; 72 (3): 176-181.
Category: Original Papers

Overview

Objective:
Extraesophageal symptoms of gastroesophageal reflux disease (GERD) represent a diverse group of symptoms and diseases. It is assumed that these symptoms and diseases are formed, maintained or aggravated by reflux. Our aim was to highlight the issue of extraesophageal reflux (EER) among children and to present our experience with investigations of pepsin in saliva by the immunochromatographic method – Peptest^TM.

Methods:
The research was done through two different groups of patients. In the first group of 39 pediatric patients with suspected GERD we correlated the results between 24-hour esophageal pH monitoring and Peptest. The second group consisted of 62 children with suspected EER - all underwent the laryngeal examination by an ENT specialist and quantitative examination of pepsin levels in two saliva samples. Outcomes of these investigations were correlated with clinical difficulties of pediatric patients.

Results:
In the first group, 17 patients out of 39 were found to have an abnormal pH monitoring. At least one positive pepsin (PeptestTM) result was seen in 82.4% of them. Conversely, 90.9% of patients with physiological pH records had positive at least one saliva sample.

In the second group was pepsin in saliva confirmed in all 62 children with suspected EER. 50% of all samples of saliva showed high pepsin levels (>500 ng/ml). Higher pepsin levels in saliva have been reported in patients with associated ENT finding (laryngitis posterior, chronic pharyngitis). We have not noticed a significant correlation between the pepsin levels in saliva and the incidence of individual symptoms. The most common symptoms of our EER-positive pediatric patients were excessive production of phlegm in the throat and the need cleared his throat (cough).

Conclusion:
We did not find a direct correlation between 24-h pH monitoring and pepsin detection in saliva in children. Peptest sensitivity due to the pH monitoring was 82.4%. The specificity of the test have not been established because of the absence a control group. However, up to 90.9% of patients with physiological pH records had positive pepsin in saliva. A much closer relationship seems to be between clinical sign of EER and pepsin detection (in our cohort the sensitivity of the Peptest was 100%). Therefore, if suspected extraesophageal reflux in children we prefer testing saliva or sputum for the presence of pepsin over traditional 24-hour pH monitoring.

KEY WORDS:
extraesophageal reflux, pepsin in the saliva

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