The Association of Pepsin and Reflux in US Individuals Self-diagnosing their Reflux like Symptoms

Main Article Content

Katie H A Boulton Jeanine Fisher Andrew D Woodcock Peter W Dettmar

Abstract

Background: A high number of US citizens experience gastroesophageal reflux disease (GERD) symptoms at least once a month. These symptoms have a great impact on an individual’s quality of life and present a huge burden on healthcare systems. Diagnosis of GERD like symptoms is not straight forward and many individuals do not have a diagnosis with current tests being invasive, expensive and often with low patient compliance. To speed the diagnosis process up there are many individuals seeking self-diagnosis and it became apparent that an easily accessible, rapid, non-invasive and cost-effective diagnostic test would be well received by individuals.


Methods:  Seven hundred and ninety-three self-referral individuals experiencing reflux like symptoms provided up to three saliva samples. The first on waking, the other two samples provided either post-prandial or post-symptom. All saliva samples were sent to a central laboratory for pepsin analysis using a lateral flow device containing two unique human monoclonal antibodies (Peptest). Following analysis, the pepsin concentration in each saliva sample was determined using a PepCube reader and expressed in ng/ml.


Results: A total of 1834 saliva samples were analysed for pepsin. Sixty-two percent of individuals tested had one or more saliva sample pepsin positive and 38% of individuals had all samples pepsin negative. The highest pepsin concentrations were seen in post-prandial samples with the lowest pepsin concentrations significantly lower (p=0.0127) in the on waking samples. The US interstate pepsin concentration data is limited due to low numbers of self-diagnosing individuals tested to date. There was no difference in pepsin concentrations between genders.


Conclusion: The individuals self-diagnosing their reflux like symptoms were mostly those aged 40 to 70 years. The availability of a simple easy to use non-invasive test for self-diagnosis is now widely accessible across all states of the US. 

Keywords: Salivary pepsin, Biomarker, Self-diagnosis, Reflux symptoms, Reflux diagnosis

Article Details

How to Cite
BOULTON, Katie H A et al. The Association of Pepsin and Reflux in US Individuals Self-diagnosing their Reflux like Symptoms. Medical Research Archives, [S.l.], v. 8, n. 12, dec. 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2294>. Date accessed: 25 apr. 2024. doi: https://doi.org/10.18103/mra.v6i12.2294.
Section
Research Articles

References

1. de Bortoli, N., et al., Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann Gastroenterol, 2018. 31(6): p. 639-648. doi: 10.20524/aog.2018.0314
2. de Bortoli, N., et al., Proton pump inhibitor responders who are not confirmed as GERD patients with impedance and pH monitoring: who are they? Neurogastroenterol Motil, 2014. 26(1): p. 28-35. doi:10.1111/nmo.12221
3. NationalHeartburnAlliancesurvey. National Heartburn Alliance. Survey 2000 Results: A Community Perspective. 2000 April 17,2020; Available from: http://www.heartburnalliance.org/press-heartburn-survey.php.
4. Sharma, N., et al., An analysis of persistent symptoms in acid-suppressed patients undergoing impedance-pH monitoring. Clin Gastroenterol Hepatol, 2008. 6(5): p. 521-4. doi:10.1016/j.cgh.2008.01.006
5. Vaezi, M.F., P.L. Schroeder, and J.E. Richter, Reproducibility of proximal probe pH parameters in 24-hour ambulatory esophageal pH monitoring. Am J Gastroenterol, 1997. 92(5): p. 825-9.
6. Du, X., et al., The diagnostic value of pepsin detection in saliva for gastro-esophageal reflux disease: a preliminary study from China. BMC Gastroenterology, 2017. 17(107): p. 1-9. doi:10.1186/s12876-017-0667-9
7. Wang, Y.F., et al., Validation in China of a non-invasive salivary pepsin biomarker containing two unique human pepsin monoclonal antibodies to diagnose gastroesophageal reflux disease. J Dig Dis, 2019. 20(6): p. 278-287. doi:10.1111/1751-2980.12783
8. Wang, Y.-J., et al., Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders. JNM, 2020. 26(1): p. 74-84. doi: 10.5056/jnm19032
9. Bardhan, K.D., V. Strugala, and P.W. Dettmar, Reflux Revisited: Advancing the Role of Pepsin. Int J Otolaryngol, 2012. 2012: p. 1-13. doi: 10.1155/2012/646901
10. Strugala, V., et al., Detection of pepsin in sputum: A rapid and objective measure of airways reflux. European Respiratory Journal, 2015. 47: p. 339-341. doi:10.1183/13993003.00827-2015
11. Strugala, V., et al., Use of pepsin detection to identify airways reflux in a range of pulmonary diseases. Clin Respir J, 2017. 11(5): p. 666-667. doi: 10.1111/crj.12395
12. Hayat, J.O., et al., Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease. Gut, 2015. 64(3): p. 373-380. doi: 10.1136/gutjnl-2014-307049
13. Crossfield, G., et al., Pepsin detection despite the use of acid suppressant medication in patients with airway reflux related chronic cough. Vol. 68 (Suppl 3). 2013; 68 (suppl 3): A19: Thorax. doi: 10.1136/thoraxjnl-2013-204457.38
14. Richter, J.E. and J.H. Rubenstein, Presentation and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology, 2018. 154(2): p. 267-276. doi: 10.1053/j.gastro.2017.07.045
15. Peery, A.F., et al., Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology, 2012. 143(5): p. 1179-1187. doi: 10.1053/j.gastro.2012.08.002
16. Boeckxstaens, G., et al., Symptomatic reflux disease: the present, the past and the future. Gut, 2014. 63(7): p. 1185-93. doi: 10.1136/gutjnl-2013-306393
17. Bytzer, P., et al., Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol, 2012. 10(12): p. 1360-6.
18. Kessing, B.F., et al., Effects of anxiety and depression in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol, 2015. 13(6): p. 1089-95. doi: 10.3748/wjg.v21.i14.4302
19. Van Oudenhove, L., et al., Relationship between anxiety and gastric sensorimotor function in functional dyspepsia. Psychosom Med, 2007. 69(5): p. 455-63. doi: 10.1097/PSY.0b013e3180600a4a
20. Jansson, C., et al., Severe gastro-oesophageal reflux symptoms in relation to anxiety, depression and coping in a population-based study. Aliment Pharmacol Ther, 2007. 26(5): p. 683-91. doi: 10.1111/j.1365-2036.2007.03411.x
21. Schwartz, M.P. and A.J. Smout, Review article: The endoscopic treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2007. 26 Suppl 2: p. 1-6. doi: 10.1111/j.1365-2036.2007.03473.x
22. Hershcovici, T. and R. Fass, An algorithm for diagnosis and treatment of refractory GERD. Best Pract Res Clin Gastroenterol, 2010. 24(6): p. 923-36. doi: 10.1016/j.bpg.2010.10.004
23. Spechler, S.J., et al., Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA, 2001. 285(18): p. 2331-8. doi: 10.1001/jama.285.18.2331
24. Eusebi, L.H., et al., Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut, 2018. 67(3): p. 430-440. doi: 10.1136/gutjnl-2016-313589
25. Bor, S., et al., Validation of Peptest in Patients with Gastro-Esophageal Reflux Disease and Laryngopharyngeal Reflux Undergoing Impedance Testing. J Gastrointestin Liver Dis, 2019. 28(4): p. 383-387. doi: 10.15403/jgld-335
26. Dettmar, P., et al., A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients. SN Compr Clin Med, 2019. 2: p. 57-65. doi: 10.1007/s42399-019-00184-0
27. Dettmar, P.W., et al., Pepsin Detection as a Diagnostic Test for Reflux Disease, in Reflux Aspiration and Lung Disease. 2018, Springer International Publishing: United Kingdom. p. 91-104. doi: 10.1007/978-3-319-90525-9_8