Pepsin assay: a marker for reflux in pediatric glue ear

Otolaryngol Head Neck Surg. 2007 Mar;136(3):464-70. doi: 10.1016/j.otohns.2006.08.030.


Objective: To evaluate if analysis of pepsin/pepsinogen in middle ear effusions can be considered a diagnostic marker for laryngopharyngeal reflux (LPR) in children with otitis media with effusion (OME).

Material and methods: Ambulatory 24-hour dual-probe pH monitoring was carried out on 31 children with OME. Middle ear effusions were collected from 17 children during myringotomy. Total pepsin/pepsinogen concentrations in effusions were measured by ELISA using antipepsin antibody.

Results: Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant LPR. The concentrations of pepsin/pepsinogen in middle ear effusions, ranged from 0.085 to 5.02 microg/ml, were found to be up to 4.5 to 231.44 times higher than the serum levels. There was a significant positive correlation between the level of pepsin/pepsinogen assayed in the effusions of the 17 children and the number of pharyngeal reflux episodes measured by pH monitoring.

Conclusions: Control of LPR may be an essential component in the successful management of OME in pediatric patients. Pepsin/pepsinogen analysis in effusions of children, using ELISA, can be considered a reliable marker for assessment of reflux in children with OME.

Publication types

  • Comparative Study

MeSH terms

  • Adenoidectomy
  • Biomarkers / analysis
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Enzyme-Linked Immunosorbent Assay
  • Esophageal pH Monitoring
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / physiopathology
  • Humans
  • Hypopharynx / physiopathology*
  • Infant
  • Middle Ear Ventilation
  • Monitoring, Ambulatory / methods
  • Otitis Media with Effusion / diagnosis*
  • Otitis Media with Effusion / physiopathology
  • Pepsin A / analysis*
  • Pepsin A / blood
  • Pepsinogen A / analysis*
  • Pepsinogen A / blood
  • Prospective Studies
  • Tonsillectomy


  • Biomarkers
  • Pepsinogen A
  • Pepsin A