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, 14 (4), 535-542.e2

Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

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Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

Rena Yadlapati et al. Clin Gastroenterol Hepatol.

Abstract

Background & aims: It has been a challenge to confirm the association between laryngeal symptoms and physiological reflux disease. We examined the ability of oropharyngeal pH tests (with the Restech Dx-pH system) and salivary pepsin tests (with Peptest) to discriminate between asymptomatic volunteers (controls) and subjects with a combination of laryngeal and reflux symptoms (laryngeal ± reflux).

Methods: We performed a physician-blinded prospective cohort study of 59 subjects at a single academic institution. Adult volunteers were recruited and separated into 3 groups on the basis of GerdQ and Reflux Symptom Index scores: controls (n = 20), laryngeal symptoms (n = 20), or laryngeal + reflux symptoms (n = 19). Subjects underwent laryngoscopy and oropharyngeal pH tests and submitted saliva samples for analysis of pepsin concentration. Primary outcomes included abnormal acid exposure and composite (RYAN) score for oropharyngeal pH tests and abnormal mean salivary pepsin concentration that was based on normative data.

Results: Complete oropharyngeal pH data were available from 53 subjects and complete salivary pepsin data from 35 subjects. We did not observe any significant differences between groups in percent of time spent below pH 4.0, 5.0, 5.5, 6.0, or RYAN scores or percent of subjects with positive results from tests for salivary pepsin (53% vs 40% vs 75%; P = .50, respectively). The laryngeal + reflux group had a significantly higher estimated mean concentration of salivary pepsin (117.9 ± 147.4 ng/mL) than the control group (32.4 ± 41.9 ng/mL) or laryngeal symptom group (7.5 ± 11.2 ng/mL) (P = .01 and P = .04, respectively).

Conclusions: By using current normative thresholds, oropharyngeal pH testing and salivary pepsin analysis are not able to distinguish between healthy volunteers and subjects with a combination of laryngeal and reflux symptoms.

Keywords: Extraesophageal Reflux; Gastroesophageal Reflux; Oropharyngeal pH Testing; Salivary Pepsin Analysis.

Conflict of interest statement

Disclosures/Conflicts of Interest: The authors do not have any disclosures or potential conflicts of interest, with the exception of: RY: Supported by T32 DK101363-02 grant; JEP: Consults for Covidien, Sandhill Scientific, and Given.

Figures

Figure 1
Figure 1
Semi-quantitative visual estimation of salivary pepsin concentration.
Figure 2
Figure 2
Breakdown of subjects. Fifty-nine subjects were recruited: 20 controls, 20 laryngeal and 19 laryngeal+reflux. Six (2, 2, 2, respectively) were excluded from oropharyngeal pH testing results due to data recording error. Thirty-five subjects overall submitted saliva for pepsin analysis, 31 also had interpretable oropharyngeal pH data.
Figure 3
Figure 3
(Top) Baseline oropharyngeal pH tracing with mealtimes excluded for an asymptomatic healthy volunteer. (Bottom) At baseline, the upright RYAN score is abnormal (11.58) due to a 9-minute post-supine lag period where the oropharyngeal pH remains below 5.5 in the upright position. When this 9-minute post-supine lag period is accounted for, the upright RYAN score normalizes to 2.12.

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