Research Article
Volume 7 Issue 10 - 2020
Pepsin as a Biomarker for Self-Diagnosing Reflux Associated Symptoms
Katie H A Boulton*, Jeanine Fisher, Andrew D Woodcock and Peter W Dettmar
RD Biomed Limited, Castle Hill Hospital, Cottingham, UK
*Corresponding Author: Katie H A Boulton, RD Biomed Limited, Castle Hill Hospital, Cottingham, UK.
Received: August 19, 2020; Published: September 15, 2020




Abstract

Background: An increasing number of individuals are seeking self-diagnosis for their reflux related symptoms in the UK. Many individuals present with troublesome symptoms, such as regurgitation, heartburn and hoarseness and want a quick non-invasive diagnosis. Pepsin is produced in the stomach and is present in the backflow of gastric refluxate, therefore an excellent biomarker for reflux within a saliva sample. The aim of the study was to show how pepsin can be used as a biomarker for reflux, using the non-invasive diagnostic Peptest for the self-diagnosis of reflux related symptoms.

Methods: A total of 739 self-referral individuals [328 males, 411 females] provided three saliva samples for pepsin analysis. The first saliva sample taken ‘on waking’, the other two samples taken either post-prandial or post-symptom. The lateral flow device Peptest was used to detect pepsin in saliva and a PepCube reader used to determine the concentration of pepsin [ng/ml] in the sample.

Results: A total of 739 self-referral individuals provided saliva samples, the mean age of all individuals was 53 years. A total of 489 [66%] individuals had one or more saliva samples pepsin positive with an overall mean pepsin concentration of 205 ng/ml ± 4.8. 250 [34%] of individuals had pepsin negative saliva samples.

Conclusion: Peptest gives individuals access to a non-invasive diagnostic test for self-diagnosing reflux related symptoms, using pepsin as the biomarker for detecting salivary pepsin.

Keywords: Saliva Samples; Pepsin; Biomarker; Reflux Diagnosis; Reflux Symptoms

References

  1. Weitzendorfer M., et al. “Role of Pepsin and Oropharyngeal pH-Monitoring to Assess the Postoperative Outcome of Patients with Laryngopharyngeal Reflux: Results of a Pilot Trial”. Journal of Laparoendoscopic and Advanced Surgical Techniques 9 (2017): 937-943.
  2. Wang J., et al. “Pepsin in saliva as a diagnostic biomarker in laryngopharyngeal reflux: a meta-analysis”. European Archives of Oto-Rhino-Laryngology3 (2018): 671-678.
  3. Wang YJ., et al. “Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders”. Journal of Neurogastroenterology and Motility1 (2020): 74-84.
  4. Eusebi LH., et al. “Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis”. Gut 3 (2018): 430-440.
  5. Wang YF., et al. “Validation in China of a non-invasive salivary pepsin biomarker containing two unique human pepsin monoclonal antibodies to diagnose gastroesophageal reflux disease”. Journal of Digestive Diseases 6 (2019): 278-287.
  6. Hicks DM., et al. “The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers”. Journal of Voice 4 (2002): 564-579.
  7. Printza A., et al. “Is pepsin detected in the saliva of patients who experience pharyngeal reflux?” Hippokratia Quarterly Medical Journal3 (2007): 145-149.
  8. Arul P., et al. “Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases”. Malaysian Journal of Pathology3 (2014): 181-188.
  9. Bor S., et al. “Validation of Peptest in Patients with Gastro-Esophageal Reflux Disease and Laryngopharyngeal Reflux Undergoing Impedance Testing”. Journal of Gastrointestinal and Liver Disease 4 (2019): 383-387.
  10. Value of reflux diagnostic questionnaire in the diagnosis of gastroesophageal reflux disease”. Chinese Journal of Digestive Diseases 5 (2004): 51-55.
  11. Klimara MJ., et al. “Correlation of salivary and nasal lavage pepsin with MII-pH testing”. The Laryngoscope 4 (2019): 961-966.
  12. Fahim A., et al. “Gastroesophageal reflux and idiopathic pulmonary fibrosis: a prospective study”. Medicina (Kaunas) 4 (2011): 200-205.
  13. Wang CP., et al. “Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux: Pepsin Detection in Laryngopharyngeal Reflux”. The Laryngoscope 129 (2019): 709-714.
  14. McCann AJ., et al. “The role of pepsin in epithelia-mesenchymal transition in idiopathic subglottic stenosis”. The Laryngoscope1 (2020): 154-158.
  15. Spyridoulias A., et al. “Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?” Respiratory Medicine8 (2015): 963-969.
  16. Bardhan KD., et al. “Reflux Revisited: Advancing the Role of Pepsin”. International Journal of Otolaryngology (2012): 1-13.
  17. Strugala V., et al. “Detection of pepsin in sputum: A rapid and objective measure of airways reflux”. European Respiratory Journal 47 (2015): 339-341.
  18. Strugala V., et al. “Use of pepsin detection to identify airways reflux in a range of pulmonary diseases”. The Clinical Respiratory Journal5 (2017): 666-667.
  19. Hayat JO., et al. “Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease”. Gut 3 (2014): 373-380.
  20. Liu S., et al. “Research on Gastroesophageal Reflux Disease Based on Dynamic Features of Ambulatory 24-Hour Esophageal pH Monitoring”. Computational and Mathematical Methods Medicine (2017): 9239074.
  21. De Bortoli N., et al. “Proton pump inhibitor responders who are not confirmed as GERD patients with impedance and pH monitoring: who are they?” Neurogastroenterology Motility 1 (2014): 28-35.
  22. Dettmar P., et al. “A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients”. SN Comprehensive Clinical Medicine 2 (2019): 57-65.
  23. Samuels TL and N Johnston. “Pepsin as a causal agent of inflammation during nonacidic reflux”. Otolaryngology - Head and Neck Surgery5 (2009): 559-563.
  24. Samuels T and N Johnston. “Pepsin as a Marker of Extraesophageal Reflux”. Annals of otology, Rhinology and Laryngology 119 (2010): 203-208.
  25. Heda R and CR Tombazzi. “Physiology, Pepsin”. In Stat Pearls. Treasure Island (FL) (2020).
  26. Lee YJ., et al. “Optimization of Saliva Collection and Immunochromatographic Detection of Salivary Pepsin for Point-of-Care Testing of Laryngopharyngeal Reflux”. Sensors (Basel)1 (2020).
  27. Ocak E., et al. “Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux”. Balkan Medical Journal 1 (2015): 46-50.
  28. Haddad HA., et al. “Salivary pepsin A detection related to gastro-oesophageal reflux episodes in children undergoing impedance probe monitoring”. Acta Paediatrica (2020).
  29. Bor S., et al. “Validation of PeptestTM in Gastro-esophageal reflux disease and Laryngopharyngeal reflux patients undergoing impedance testing”. Journal of Gastrointestinal and Liver Diseases4 (2019): 383-387.
  30. Johnston N., et al. “Laryngopharyngeal reflux and GERD”. Annals of the New York Academy of Sciences 1 (2013): 71-79.
  31. Hayat JO., et al. “Objective Detection of Esophagopharyngeal Reflux in Patients With Hoarseness and Endoscopic Signs of Laryngeal Inflammation”. Journal of Clinical Gastroenterology4 (2014): 318-327.
  32. Calvo-Henríquez C., et al. “Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review”. Otolaryngology - Head and Neck Surgery3 (2017): 385-391.
  33. Strugala V., et al. “Differentiation between LPR and GORD with the use of a simple non-invasive diagnostic test for reflux by detection of pepsin in expectorated saliva”. In 15th British Academic Conference in Otolaryngology and ENT Expo (2015).
  34. El-Serag HB., et al. “Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review”. Gut6 (2014): 871-880.
  35. Talley NJ. “Review article: gastro-oesophageal reflux disease -- how wide is its span?” Alimentary Pharmacology and Therapeutics5 (2004): 27-37.
  36. Chatila AT., et al. “Natural history, pathophysiology and evaluation of gastroesophageal reflux disease”. Disease-A-Month 1 (2020): 100848.
Citation: Katie H A Boulton., et al. “Pepsin as a Biomarker for Self-Diagnosing Reflux Associated Symptoms”. EC Gastroenterology and Digestive System 7.10 (2020): 49-56.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 15, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.