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Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication

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Abstract

Background

Some patients with gastroesophageal reflux disease (GERD) suffer from laryngopharyngeal reflux (LPR). There is no reliable diagnostic test for LPR as there is for GERD. We hypothesized that detection of pepsin (a molecule only made in the stomach) in laryngeal epithelium or sputum should provide evidence for reflux of gastric contents to the larynx, and be diagnostic of LPR. We tested this hypothesis in a prospective study in patients with LPR symptoms undergoing antireflux surgery (ARS).

Methods

Nine patients undergoing ARS for LPR symptoms were studied pre- and postoperatively using a clinical symptom questionnaire, laryngoscopy, 24-h pH monitoring, biopsy of posterior laryngeal mucosa, and sputum collection for pepsin Western blot assay.

Results

The primary presenting LPR symptom was hoarseness in six, cough in two, and globus sensation in one patient. Pepsin was detected in the laryngeal mucosa in eight of nine patients preoperatively. There was correlation between biopsy and sputum (+/+ or −/−) in four of five patients, both analyzed preoperatively. Postoperatively, pH monitoring improved in all but one patient and normalized in five of eight patients. Eight of nine patients reported improvement in their primary LPR symptom (six good, two mild). Only one patient (who had negative preoperative pepsin) reported no response to treatment of the primary LPR symptom. Postoperatively, pepsin was detected in only one patient.

Conclusions

Pepsin is often found on laryngeal epithelial biopsy and in sputum of patients with pH-test-proven GERD and symptoms of LPR. ARS improves symptoms and clears pepsin from the upper airway. Detection of pepsin improves diagnostic accuracy in patients with LPR.

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Acknowledgments

This study was supported in part by a SAGES research grant and the Byers Endowment in Esophageal Research at the University of Washington.

Disclosures

Author Eelco Wassenaar is currently in a fellowship that is funded through Covidien. Author Nikki Johnston is a consultant for Koufman Diagnostics. Author Albert Merati has no conflicts of interest or financial ties to disclose. Author Martin Montenovo has no conflicts of interest or financial ties to disclose. Author Rebecca Petersen is currently in a fellowship that is funded through Covidien. Author Roger Tatum has no conflicts of interest or financial ties to disclose. Author Carlos Pellegrini receives research grants from Cook Biotech, Inc., and Stryker, serves on the scientific advisory board of Torax Medical, and his wife is employed by Covidien. Author Brant Oelschlager receives research grants from Cook Biotech, Inc., W.L. Gore, Torax Medical, Synovis Surgical Innovations, and Takeda Pharmaceuticals, receives an education grant, consulting for Covidien, and is on the speakers bureau of Endogastric Solutions.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, 98195, Seattle, WA, USA

    Eelco Wassenaar, Martin Montenovo, Rebecca Petersen, Roger Tatum, Carlos Pellegrini & Brant Oelschlager

  2. Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA

    Nikki Johnston

  3. Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA

    Albert Merati

Authors
  1. Eelco Wassenaar
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  2. Nikki Johnston
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  3. Albert Merati
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  4. Martin Montenovo
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  5. Rebecca Petersen
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  6. Roger Tatum
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  7. Carlos Pellegrini
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  8. Brant Oelschlager
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Corresponding author

Correspondence to Eelco Wassenaar.

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Wassenaar, E., Johnston, N., Merati, A. et al. Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication. Surg Endosc 25, 3870–3876 (2011). https://doi.org/10.1007/s00464-011-1813-z

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  • DOI: https://doi.org/10.1007/s00464-011-1813-z

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