What is the optimal time point for diagnosing laryngopharyngeal reflux (LPR) through combining 24-hour hypopharyngeal-esophageal multi-channel intraluminal impedance-pH (24h- HEMII-pH) monitoring and the multi-time point salivary pepsin test (MTPSPT)?
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July 2023The MTPSPT is a good diagnostic method for LPR and is expected to replace HEMII-pH as the first-line diagnostic method.
BACKGROUND: Twenty-four hour HEMII-pH LPR monitoring is considered the gold standard for LPR diagnosis, but it is invasive and expensive. Salivary pepsin testing is another diagnostic tool for LPR, and the rapid test strip method eases the process, but there is currently no consensus on the optimal timing of saliva collection.
STUDY DESIGN: Prospective trial.
SETTING: Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, China.
SYNOPSIS: Researchers selected 125 patients with pharyngeal reflux symptoms hospitalized at a single institution; 28 patients without reflux symptoms were included as controls. Test group patients underwent 24h-HEMII-pH and MTPSPT. Results of the 24h-HEMII-pH were used as a diagnostic criterion for LPR, and the diagnostic value of salivary pepsin tests performed at different time points was compared by receiver operating characteristic curve analysis. Based on 24h-HEMII-pH, the positive rate of LPR in the test group was 84.00%. In the control group, only one person had a positive salivary pepsin test result. The area under the curve (AUC) of the MTPSPT was 0.827. The AUC of the combined salivary pepsin test at different time points showed good diagnostic value (0.799) when the test was combined with waking, one/two hours after breakfast and lunch, and one hour after dinner tests. The diagnostic value did not improve significantly when the number of tests was further increased.
CITATION: Zhang J, Wang X, Wang J, et al. Optimal timing of the salivary pepsin test for the diagnosis of laryngopharyngeal reflux. Laryngoscope. 2023;133:1706–1711.