Abilities of Oropharyngeal pH Tests and Salivary Pepsin Analysis to Discriminate Between Asymptomatic Volunteers and Subjects With Symptoms of Laryngeal Irritation

Rena Yadlapati, Christopher Adkins, Diana Marie Jaiyeola, Alcina K. Lidder, Andrew J. Gawron, Bruce K. Tan, Nadine Shabeeb, Caroline P.E. Price, Neelima Agrawal, Michael Ellenbogen, Stephanie S. Smith, Michiel Bove, John E. Pandolfino

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: It has been a challenge to confirm the association between laryngeal symptoms and physiological reflux disease. We examined the ability of oropharyngeal pH tests (with the Restech Dx-pH system) and salivary pepsin tests (with Peptest) to discriminate between asymptomatic volunteers (controls) and subjects with a combination of laryngeal and reflux symptoms (laryngeal ± reflux). Methods: We performed a physician-blinded prospective cohort study of 59 subjects at a single academic institution. Adult volunteers were recruited and separated into 3 groups on the basis of GerdQ and Reflux Symptom Index scores: controls (n = 20), laryngeal symptoms (n = 20), or laryngeal + reflux symptoms (n = 19). Subjects underwent laryngoscopy and oropharyngeal pH tests and submitted saliva samples for analysis of pepsin concentration. Primary outcomes included abnormal acid exposure and composite (RYAN) score for oropharyngeal pH tests and abnormal mean salivary pepsin concentration that was based on normative data. Results: Complete oropharyngeal pH data were available from 53 subjects and complete salivary pepsin data from 35 subjects. We did not observe any significant differences between groups in percent of time spent below pH 4.0, 5.0, 5.5, 6.0, or RYAN scores or percent of subjects with positive results from tests for salivary pepsin (53% vs 40% vs 75%; P = .50, respectively). The laryngeal + reflux group had a significantly higher estimated mean concentration of salivary pepsin (117.9 ± 147.4 ng/mL) than the control group (32.4 ± 41.9 ng/mL) or laryngeal symptom group (7.5 ± 11.2 ng/mL) (P = .01 and P = .04, respectively). Conclusions: By using current normative thresholds, oropharyngeal pH testing and salivary pepsin analysis are not able to distinguish between healthy volunteers and subjects with a combination of laryngeal and reflux symptoms.

Original languageEnglish (US)
Pages (from-to)535-542.e2
JournalClinical Gastroenterology and Hepatology
Volume14
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • Extraesophageal Reflux
  • Gastroesophageal Reflux
  • Oropharyngeal pH Testing
  • Salivary Pepsin Analysis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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