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Keywords:

  • Pepsin;
  • immunoassay;
  • larynx;
  • laryngopharyngeal reflux;
  • gastroesophageal reflux;
  • GERD;
  • pH monitoring;
  • sputum;
  • reflux laryngitis;
  • diagnosis

Abstract

Objectives/Hypothesis: To determine whether measurement of pepsin in throat sputum by immunoassay could be used as a sensitive and reliable method for detecting laryngopharyngeal reflux (LPR) compared with 24-hour double-probe (esophageal and pharyngeal) pH monitoring.

Study Design: Patients with clinical LPR undergoing pH monitoring provided throat sputum samples during the reflux-testing period for pepsin measurement using enzyme-linked immunoadsorbent assay.

Results: Pepsin assay results from 63 throat sputum samples obtained from 23 study subjects were compared with their pH monitoring data. Twenty-two percent (14/63) of the sputum samples correlated the presence of pepsin with LPR (pH ≤ 4 at the pharyngeal probe), of which the median concentration of pepsin was 0.18 μg/mL (range 0.003–22 μg/mL). Seventy-eight percent (49/63) of the samples unassociated with (pharyngeal) reflux contained no detectible pepsin. Mean pH values for pepsin-positive samples were significantly lower than negative samples at both esophageal probe (pH 2.2 vs. pH 5.0) (P < .01) and the pharyngeal probe (pH 4.4 vs. pH 5.8) (P < .01). When the pepsin assay results were compared with the pharyngeal pH data for detecting reflux (events pH ≤ 4), the pepsin immunoassay was 100% sensitive and 89% specific for LPR.

Conclusions: Detection of pepsin in throat sputum by immunoassay appears to provide a sensitive, noninvasive method to detect LPR.