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. 2024 Jul 17;11(2):241-249.
doi: 10.1002/wjo2.200. eCollection 2025 Jun.

Diagnostic value of fasting hypopharyngeal salivary pepsin concentration test for laryngopharyngeal reflux disease

Chao-Feng Liu  1   2 , Chen-Jie Hou  1 , Ting Chen  1 , Liu-Qing Chen  3 , Jing-Yi Zheng  1 , Yu-Jin Zheng  1 , Xiao-Wei Zheng  1
Affiliations

Diagnostic value of fasting hypopharyngeal salivary pepsin concentration test for laryngopharyngeal reflux disease

Chao-Feng Liu et al. World J Otorhinolaryngol Head Neck Surg. .

Abstract

Objective: To investigate the diagnostic value of the fasting hypopharyngeal salivary pepsin concentration test for laryngopharyngeal reflux disease (LPRD).

Methods: Volunteers were grouped by reflux symptom index scale, reflux finding score scale, and 24-h hypopharyngeal-esophageal multichannel intraluminal impedance with pH monitoring results. The study comprised 56, 27, and 20 individuals in the LPRD, asymptomatic laryngopharyngeal reflux (LPR), and asymptomatic non-LPR groups, respectively. All underwent a fasting hypopharyngeal saliva pepsin testing via enzyme-linked immunosorbent assay. Statistical analysis determined the optimal diagnostic cutoff value, sensitivity, and specificity of hypopharyngeal salivary pepsin for LPRD. Correlation analysis was performed with reflux scale scores and LPR parameters.

Results: Fasting hypopharyngeal salivary pepsin concentration in the LPRD group was significantly higher than in the asymptomatic control group (Z = -4.724, p < 0.05). The area under the receiver operating characteristic curve (AUC) analysis identified an optimal cutoff value of 29.62 ng/mL for salivary pepsin concentration (AUC, 0.767; sensitivity, 51.8%; and specificity, 93.6%). There was no statistically significant difference in salivary pepsin concentration between the asymptomatic LPR and non-LPR groups. The concentration was higher in the LPRD group than in the asymptomatic LPR and non-LPR groups (p < 0.05). Fasting hypopharyngeal salivary pepsin concentration exhibited a weakly positive correlation with vocal cord edema, intralaryngeal mucus adherence, excess throat mucus or postnasal drip, coughing during meals/lying down, troublesome or annoying cough, and liquid and weakly acidic reflux episodes.

Conclusions: The fasting hypopharyngeal salivary pepsin concentration test is a highly specific, simple, and noninvasive method with significant clinical diagnostic value for LPRD.

Keywords: diagnosis; fasting; hypopharynx; laryngopharyngeal reflux disease; saliva pepsin.

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Conflict of interest statement

Professor Ting Chen is a member of the World Journal of Otorhinolaryngology‐Head & Neck Surgery (WJOHNS) editorial board and is not involved in the peer review process of this article. Other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic diagram of the 24‐h HEMII‐pH monitoring catheter. (A) There is a 1‐cm distance between the impedance electrodes. The Z1 channel is located between the hypopharynx and the upper border of the UES. Z2 and Z3 channels are located in the upper and lower segments of the UES, respectively. The Z4 channel is located in the proximal esophagus. The reference electrode is located 9 cm below the lower border of the UES, and the pH electrode is located 0.5 cm below the upper border of the UES. (B) Laryngoscopic view of the catheter localization. (C) Physical picture of the 24‐h HEMII‐pH monitoring catheter. HEMII, hypopharyngeal‐esophageal multichannel intraluminal impedance; UES, upper esophageal sphincter.
Figure 2
Figure 2
ROC curve of salivary pepsin concentration. AUC, area under the curve; ROC, receiver operating characteristic.
Figure 3
Figure 3
Comparison of salivary pepsin concentration among the three subgroups. LPR, laryngopharyngeal reflux; LPRD, laryngopharyngeal reflux disease.
Figure 4
Figure 4
Correlation between salivary pepsin concentration and LPR symptoms/signs and laryngopharyngeal reflux parameters. LPR, laryngopharyngeal reflux; RFS, reflux finding score; RSI, reflux symptom index.
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