The authors have no funding, financial relationships, or conflicts of interest to disclose.
Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux†
Article first published online: 6 JUN 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 7, pages 1426–1430, July 2011
How to Cite
Jiang, A., Liang, M., Su, Z., Chai, L., Lei, W., Wang, Z., Wang, A., Wen, W. and Chen, M. (2011), Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux. The Laryngoscope, 121: 1426–1430. doi: 10.1002/lary.21809
- Issue published online: 16 JUN 2011
- Article first published online: 6 JUN 2011
- Manuscript Accepted: 2 MAR 2011
- Manuscript Revised: 25 FEB 2011
- Manuscript Received: 9 NOV 2010
- Laryngopharyngeal reflux;
- multichannel intraluminal impedance;
- pH monitoring;
- immunohistochemical staining;
- Level of Evidence: 3b.
To investigate whether the pepsin immunohistochemical (IHC) staining of the laryngeal mucosa epithelia is an available test for diagnosing laryngopharyngeal reflux (LPR) in clinic.
Prospective case series.
Biopsy specimens from interarytenoid mucosa of LPR patients (seven acid LPR and eight nonacid LPR) and 21 sex- and age-matched normal controls were obtained for pepsin IHC staining. The diagnosis of LPR was based on 24-hour combined multichannel intraluminal esophageal impedance pH monitoring. The results of IHC staining were semiquantitatively analyzed and scored as negative (−), weakly positive (+), moderately positive (++), and strongly positive (+++).
Six of seven acid LPR (85.7%) and six of eight nonacid LPR (75%) mucosa samples were moderate to strongly positive for intracellular pepsin. By contrast, only three of 21 normal controls (14.3%) were moderately positive. The difference in intracellular pepsin between LPR and the normal laryngeal mucosa was statistically significant (P < .01). No significant difference in intracellular pepsin was observed between the acid and nonacid LPR mucosal samples (P = .453). Using weak positivity (+) as a cutpoint, the presence of intracellular pepsin in the laryngeal mucosa had a sensitivity of 100% and a specificity of 47.6% in detecting LPR (P < .05). However, using the moderate positivity (++) as the cutpoint, the pepsin had a slightly decreased sensitivity of 80% but a sharply increased specificity of 85.7% (P < .05) in the detection of LPR.
Pepsin IHC staining of the laryngeal mucosa appears to be a sensitive and specific test for diagnosing LPR in a clinical application.