Current diagnostic methods for gastro-esophageal reflux disease (GERD) have moderate sensitivity/specificity, and can be invasive and expensive.
Pepsin detection in saliva has been proposed as an ‘office-based’ method for GERD diagnosis.
Dr Daniel Sifrim and colleagues from the United Kingdom established normal values of salivary pepsin in healthy asymptomatic subjects, and to determined its value to discriminate patients with reflux-related symptoms, hypersensitive esophagus from functional heartburn.
The researchers found that 100 asymptomatic controls, and 111 patients with heartburn underwent MII-pH monitoring and simultaneous salivary pepsin determination on waking, after lunch and dinner.
Cut-off value for pepsin positivity was 16 ng/mL.
|A positive test had 79% sensitivity for diagnosis of GERD with hypersensitive esophagus|
The researchers divided patients into GERD, hypersensitive esophagus, and functional heartburn.
The team found that 33% of asymptomatic subjects had pepsin in saliva at low concentration.
The team noted that patients with GERD and hypersensitive esophagus had higher prevalence, and pepsin concentration than controls.
The research team observed that patients with functional heartburn had low prevalence and concentration of pepsin in saliva.
A positive test had 79% sensitivity and 65% specificity for diagnosis of GERD with hypersensitive esophagus.
However, the team found that 1 positive sample with >210 ng/mL pepsin suggested presence of GERD and hypersensitive esophagus with 98% specificity.
Only 21% of GERD with hypersensitive esophagus patients had 3 negative samples.
Dr Sifrim's team concludes, "In patients with symptoms suggestive of GERD, salivary pepsin testing may complement questionnaires to assist office-based diagnosis."
"This may lessen the use of unnecessary antireflux therapy and the need for further invasive and expensive diagnostic methods."