Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Jinhong Zhang; Jinrang Li; Yanping Zhang; Qian Nie; Ran Zhang; Xiaoyu Wang; Xingwang Jiang; Yingying Wu; Runze Wu; Xinxin Bi; Xiaohuan Cui; Hui Song; Taotao Ran; Lina Li

doi:10.1002/lio2.700

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Laryngoscope Investig Otolaryngol. 2021 Nov 19;6(6):1389-1394. doi: 10.1002/lio2.700. eCollection 2021 Dec.

Authors

Jinhong Zhang^{1

2}, Jinrang Li^{1

2}, Yanping Zhang³, Qian Nie², Ran Zhang², Xiaoyu Wang², Xingwang Jiang³, Yingying Wu³, Runze Wu³, Xinxin Bi³, Xiaohuan Cui³, Hui Song³, Taotao Ran³, Lina Li³

Affiliations

¹ Department of Otolaryngology School of Medicine, South China University of Technology Guangzhou China.
² Department of Otolaryngology The Sixth Medical Center of PLA General Hospital of Beijing Beijing China.
³ Department of Otolaryngology The Eighth Medical Center of Chinese PLA General Hospital Beijing China.

Abstract

Objective: To study the value of multitime point salivary pepsin testing (MTPSPT) for the diagnosis of laryngopharyngeal reflux (LPR).

Study design: Prospective noncontrolled.

Methods: For patients who met the enrollment criteria, the reflux symptom index (RSI) and reflux finding score (RFS) were calculated and salivary pepsin testing was performed. The pepsin test was performed every hour from 7:00 a.m. to 6:00 p.m. by collecting fresh saliva samples. A single positive test result was needed for the diagnosis of LPR. The consistency in the diagnosis of LPR between the two methods was compared with the weighted Cohen's kappa statistic.

Results: A total of 204 patients were included. The kappa value between the two methods was 0.566 (p = .00). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MTPSPT were 76.43%, 85.94%, 92.24%, and 62.5%, respectively. We also compared a single pepsin measure at 7 a.m. with the screening results based on the RSI and RFS, and found a much lower kappa agreement value (0.223, p = .00). The sensitivity, specificity, PPV, NPV, and false-negative rate of pepsin testing at 7 a.m. (fasting) were 37.86%, 92.18%, 91.38%, 40.41%, and 58.57%, respectively.

Conclusion: The use of the result of a single salivary pepsin test in the morning yields a relatively higher rate of missed diagnosis of LPR, and multitime point testing through a day increased the accuracy and sensitivity of detection of LPR twofold compared to a single morning fasting sample.

Level of evidence: 3.

Keywords: consistency; laryngopharyngeal reflux; pepsin; saliva.