Diagnostic value of upper esophageal sphincter pressure combined with salivary pepsin for laryngopharyngeal reflux_West China Medical Journal

Authors：

LIU Junwei ^1,2 ,  LIU Shixi ¹ , ZOU Jian ¹ , HE Wen ¹ , ZHANG Heng ² , TU Ying ³ , ZHENG Shicheng ³

1. Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Otolaryngology, Head and Neck Surgery, the First People’s Hospital of Longquanyi District, Chengdu / West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
3. Department of GAstroenterology, the First People’s Hospital of Longquanyi District, Chengdu / West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;

Corresponding?author：

LIU Shixi, Email: liusx999@163.com

Keywords：

Laryngopharyngeal reflux; salivary pepsin; esophageal high resolution manometry

DOI：

10.7507/1002-0179.202211142

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Objective To investigate the diagnostic value of esophageal high-resolution manometry combined with salivary pepsin levels in laryngopharyngeal reflux disease (LPRD). Methods The patients with the chief complaint of “throat discomfort” for treatment at the Department of Otolaryngology, Head and Neck Surgery, the First People’s Hospital of Longquanyi District, Chengdu / West China Longquan Hospital Sichuan University between January and October 2022 was selected. According to the reflux findings score and refluxsymptomindex at admission, the enrolled patients were divided into LPRD group and non-LPRD group. The basic patient information, esophageal high resolution manometry, and salivary pepsin concentration of included patients were collected. Results A total of 112 patients were included. Among them, there were 68 cases (60.7%) in the LPRD group and 44 cases (39.3%) in the non-LPRD group. The LPRD group was significantly younger (P=0.007) , but the salivary pepsin concentration (P<0.001), upper esophageal sphincter (UES) resting pressure (P<0.001) and distal contractile integral (P=0.007) were all higher than the non-LPRD group. The results of multivariate logistic regression analysis showed that salivary pepsin concentration [odds ratio (OR)=1.077, 95%CI (1.035, 1.120), P<0.001] and UES resting pressure [OR=1.035, 95%CI (1.019, 1.052), P<0.001] were independent factors for the diagnosis of LPRD. The area under the working curve (0.971), specificity (0.99), and sensitivity (0.77) in the combined index were higher than those of saliva pepsin concentration and UES resting pressure. Conclusion Esophageal high resolution manometry and salivary pepsin are significant for the diagnosis of LPRD, and their combined application can improve the diagnostic value and also serve as an alternative method for the diagnosis of LPRD.

Citation： LIU Junwei, LIU Shixi, ZOU Jian, HE Wen, ZHANG Heng, TU Ying, ZHENG Shicheng. Diagnostic value of upper esophageal sphincter pressure combined with salivary pepsin for laryngopharyngeal reflux. West China Medical Journal, 2023, 38(9): 1333-1337. doi: 10.7507/1002-0179.202211142 Copy

1.	中華耳鼻咽喉頭頸外科雜志編輯委員會咽喉組, 中華醫學會耳鼻咽喉頭頸外科學分會咽喉學組. 咽喉反流性疾病診斷與治療專家共識 (2015 年). 中華耳鼻咽喉頭頸外科雜志, 2016, 51(5): 324-326.
2.	Kakaje A, Alhalabi MM, Alyousbashi A, et al. Allergic rhinitis, asthma and laryngopharyngeal reflux disease: a cross-sectional study on their reciprocal relations. Sci Rep, 2021, 11(1): 2870.
3.	van Hoeij FB, Smout AJ, Bredenoord AJ. Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease. Neurogastroenterol Motil, 2015, 27(7): 963-970.
4.	Farhath S, He Z, Nakhla T, et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics, 2008, 121(2): e253-9.
5.	Copper MP, Smit CF, Stanojcic LD, et al. High incidence of laryngopharyngeal reflux in patients with head and neck cancer. Laryngoscope, 2000, 110(6): 1007-1011.
6.	Lechien JR, Akst LM, Hamdan AL, et al. Evaluation and management of laryngopharyngeal reflux disease: state of the art review. Otolaryngol Head Neck Surg, 2019, 160(5): 762-782.
7.	Poelmans J, Tack J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 2005, 54(10): 1492-1499.
8.	Hunt PS, Connell AM, Smiley TB. The cricopharyngeal sphincter in gastric reflux. Gut, 1970, 11(4): 303-306.
9.	Vardar R, Sweis R, Anggiansah A, et al. Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry. Dis Esophagus, 2013, 26(3): 219-225.
10.	Fox MR, Bredenoord AJ. Oesophageal high-resolution manometry: moving from research into clinical practice. Gut, 2008, 57(3): 405-423.
11.	Benjamin T, Zackria S, Lopez R, et al. Upper esophageal sphincter abnormalities and high-resolution esophageal manometry findings in patients with laryngopharyngeal reflux. Scand J Gastroenterol, 2017, 52(8): 816-821.
12.	Tsou YA, Chen SH, Wu WC, et al. Esophageal pressure and clinical assessments in the gastroesophageal reflux disease patients with laryngopharyngeal reflux disease. J Clin Med, 2021, 10(22): 5262.
13.	Koch OO, Kaindlstorfer A, Antoniou SA, et al. Influence of the esophageal hiatus size on the lower esophageal sphincter, on reflux activity and on symptomatology. Dis Esophagus, 2012, 25(3): 201-208.
14.	劉俊偉, 鄭城婷, 鄭仕誠, 等. 咽喉反流性疾病患者食管上括約肌壓力高分辨測量的診斷價值. 中國耳鼻咽喉顱底外科雜志, 2020, 26(4): 443-447.
15.	劉澤陽, 許洪波, 郭偉, 等. 胃蛋白酶在咽喉反流與喉癌中的臨床意義及研究進展. 臨床耳鼻喉頭頸外科雜志, 2018, 32(7): 559-562.
16.	Johnston N, Yan JC, Hoekzema CR, et al. Pepsin promotes proliferation of laryngeal and pharyngeal epithelial cells. Laryngoscope, 2012, 122(6): 1317-1325.
17.	Wang CP, Wang CC, Lien HC, et al. Saliva pepsin detection and proton pump inhibitor response in suspected laryngopharyngeal reflux. Laryngoscope, 2019, 129(3): 709-714.
18.	Zeleník K, Hránková V, Vrtková A, et al. Diagnostic value of the peptest^TM in detecting laryngopharyngeal reflux. J Clin Med, 2021, 10(13): 2996.

1. 中華耳鼻咽喉頭頸外科雜志編輯委員會咽喉組, 中華醫學會耳鼻咽喉頭頸外科學分會咽喉學組. 咽喉反流性疾病診斷與治療專家共識 (2015 年). 中華耳鼻咽喉頭頸外科雜志, 2016, 51(5): 324-326.
2. Kakaje A, Alhalabi MM, Alyousbashi A, et al. Allergic rhinitis, asthma and laryngopharyngeal reflux disease: a cross-sectional study on their reciprocal relations. Sci Rep, 2021, 11(1): 2870.
3. van Hoeij FB, Smout AJ, Bredenoord AJ. Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease. Neurogastroenterol Motil, 2015, 27(7): 963-970.
4. Farhath S, He Z, Nakhla T, et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics, 2008, 121(2): e253-9.
5. Copper MP, Smit CF, Stanojcic LD, et al. High incidence of laryngopharyngeal reflux in patients with head and neck cancer. Laryngoscope, 2000, 110(6): 1007-1011.
6. Lechien JR, Akst LM, Hamdan AL, et al. Evaluation and management of laryngopharyngeal reflux disease: state of the art review. Otolaryngol Head Neck Surg, 2019, 160(5): 762-782.
7. Poelmans J, Tack J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut, 2005, 54(10): 1492-1499.
8. Hunt PS, Connell AM, Smiley TB. The cricopharyngeal sphincter in gastric reflux. Gut, 1970, 11(4): 303-306.
9. Vardar R, Sweis R, Anggiansah A, et al. Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry. Dis Esophagus, 2013, 26(3): 219-225.
10. Fox MR, Bredenoord AJ. Oesophageal high-resolution manometry: moving from research into clinical practice. Gut, 2008, 57(3): 405-423.
11. Benjamin T, Zackria S, Lopez R, et al. Upper esophageal sphincter abnormalities and high-resolution esophageal manometry findings in patients with laryngopharyngeal reflux. Scand J Gastroenterol, 2017, 52(8): 816-821.
12. Tsou YA, Chen SH, Wu WC, et al. Esophageal pressure and clinical assessments in the gastroesophageal reflux disease patients with laryngopharyngeal reflux disease. J Clin Med, 2021, 10(22): 5262.
13. Koch OO, Kaindlstorfer A, Antoniou SA, et al. Influence of the esophageal hiatus size on the lower esophageal sphincter, on reflux activity and on symptomatology. Dis Esophagus, 2012, 25(3): 201-208.
14. 劉俊偉, 鄭城婷, 鄭仕誠, 等. 咽喉反流性疾病患者食管上括約肌壓力高分辨測量的診斷價值. 中國耳鼻咽喉顱底外科雜志, 2020, 26(4): 443-447.
15. 劉澤陽, 許洪波, 郭偉, 等. 胃蛋白酶在咽喉反流與喉癌中的臨床意義及研究進展. 臨床耳鼻喉頭頸外科雜志, 2018, 32(7): 559-562.
16. Johnston N, Yan JC, Hoekzema CR, et al. Pepsin promotes proliferation of laryngeal and pharyngeal epithelial cells. Laryngoscope, 2012, 122(6): 1317-1325.
17. Wang CP, Wang CC, Lien HC, et al. Saliva pepsin detection and proton pump inhibitor response in suspected laryngopharyngeal reflux. Laryngoscope, 2019, 129(3): 709-714.
18. Zeleník K, Hránková V, Vrtková A, et al. Diagnostic value of the peptest^TM in detecting laryngopharyngeal reflux. J Clin Med, 2021, 10(13): 2996.

West China Medical Journal

Diagnostic value of upper esophageal sphincter pressure combined with salivary pepsin for laryngopharyngeal reflux

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