Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux - a prospective comparative study

Clin Otolaryngol. 2015 Jun;40(3):234-9. doi: 10.1111/coa.12358.


Objectives: Laryngopharyngeal reflux (LPR) and biliary duodenogastric reflux can cause damage to the laryngeal mucosa and voice disorders. The aim of this study was to find out whether levels of pepsin and bile acids in the saliva can serve as diagnostic markers of LPR.

Setting: A prospective comparative study.

Participants: Twenty-eight patients with LPR proven via high-resolution manometry and combined multichannel intraluminal impedance and 24-h pH monitoring and 48 healthy controls without symptoms of LPR were included in the study.

Main outcome measures: In the patients with LPR symptoms, oesophagogastroscopy with oesophageal biopsy was performed. The levels of total pepsin, active pepsin, bile acids and the pH of the saliva were determined in all participants and compared between the groups. Reflux symptom index (RSI) and reflux finding score (RFS) were also obtained and compared. The groups differed significantly in RSI (P = 0.00), RFS (P = 0.00), the levels of bile acids (P = 0.005) and total pepsin in saliva (P = 0.023). The levels of total pepsin and bile acids were about three times higher in the patients with LPR than in the healthy controls. There was a significant correlation between the RSI and RFS score and the level of total pepsin and bile acids in the saliva. Histopathological examination of the oesophageal biopsy taken 5 cm above the lower oesophageal sphincter confirmed reflux in almost 93% of patients with symptoms.

Conclusions: The study results show that the levels of total pepsin and bile acids in saliva are significantly higher in patients with LPR than in the controls, thus suggesting this as a useful tool in the diagnosis of LPR and particularly biliary LPR.

Publication types

  • Comparative Study

MeSH terms

  • Bile Acids and Salts / metabolism*
  • Esophagoscopy / methods*
  • Esophagus / metabolism
  • Esophagus / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrogen-Ion Concentration
  • Laryngopharyngeal Reflux / diagnosis*
  • Laryngopharyngeal Reflux / metabolism
  • Laryngoscopy / methods*
  • Male
  • Manometry
  • Middle Aged
  • Pepsin A / metabolism*
  • Pressure
  • Prospective Studies
  • Saliva / chemistry*


  • Bile Acids and Salts
  • Pepsin A