Clinical evaluation of pepsin for laryngopharyngeal reflux in children with otitis media with effusion

Abstract

Objective: We sought to evaluate the clinical role of pepsin for laryngopharyngeal reflux (LPR) in children with otitis media with effusion (OME).

Methods: Pepsin/pepsinogen and fibrinogen were analyzed in fifty effusion and blood samples of children with OME using enzyme linked immunosorbent assay (ELISA). Ambulatory 24-h dual-probe pH monitoring was additionally performed in 31 children divided into two groups according to response of medical treatment.

Results: The effusion levels of pepsin/pepsinogen ranged from 8.5 to 1512 μg/dl and were up to 4-540 times higher than the concentrations found in plasma samples. The effusion levels of fibrinogen ranged from 0.05 to 4.1g/dl. Some effusion samples showed fibrinogen concentrations did not exceed 10 times higher than the concentrations found in plasma samples and others showed lower concentrations. The pH of effusion samples was 7.13 to 8.72. Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant acid reflux documented by either the esophageal probe or the pharyngeal probe and all of them had LPR. There is a significant positive correlation between the level of pepsin assayed in the effusions and the number of pharyngeal reflux episodes measured by pH monitoring.

Conclusions: Analysis of pepsin/pepsinogen in effusion samples of children with OME, using ELISA, can be considered as a reliable biochemical marker for assessment of laryngopharyngeal reflux.

Keywords: EER; ELISA; GERD; LPR; Laryngopharyngeal reflux; Middle ear effusion; OME; Pepsin/pepsinogen; enzyme linked immunosorbent assay; extraesophageal reflux; gastroesophageal reflux disease; laryngopharyngeal reflux; otitis media with effusion.