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, 26 (1), 74-84

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

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Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Yan-Jun Wang et al. J Neurogastroenterol Motil.

Abstract

Background/aims: To determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders.

Methods: Overall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES).

Results: Compared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett's esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES ( P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002).

Conclusions: Salivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency.

Keywords: Anxiety; Esophageal pH monitoring; Gastroesophageal reflux; Gold colloid; Saliva.

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Flowchart of recruitment of healthy controls (HC) and patients with sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. EES, extra-esophageal symptoms; NERD, non-erosive reflux disease; FH, functional heartburn; EE, erosive esophagitis; BE, Barrett’s esophagus; GERD-AD, GERD symptoms with anxiety and depression.
Figure 2
Figure 2
Scatter plot of distribution, medians and interquartile ranges (IQR; Q25, Q75) of pepsin in saliva in patients with subtypes of gastroesophageal reflux disease (GERD) and GERD-related disorders. A long horizontal line represents Median, 2 short horizontal lines represents IQR in scatter plot respectively. Compared with healthy controls (HC) group, *P < 0.001. EE, erosive esophagitis; NERD, non-erosive reflux disease; BE, Barrett’s esophagus; EES, extra-esophageal symptoms; EES + T-GERD, EES and typical GERD symptoms; FH, functional heartburn; GERD-AD, GERD symptoms with anxiety and depression.

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