Clinical Studies
Using pepsin as a biomarker for reflux led to the development of Peptest, which is a non-invasive, rapid diagnostic procedure used to identify pepsin within a saliva or sputum sample.
Peptest uses lateral flow technology containing two unique human pepsin monoclonal antibodies, one used to detect pepsin and the other to capture pepsin.
A PepCube reader is used to measure and determine pepsin concentration in ng/mL.
Here you can read and download a diverse collection of research papers that feature Peptest and pepsin.
2021: Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux
Overview: The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-hr multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR.
2020: Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad
Overview: This study evaluates the predictive value of salivary pepsin in diagnosing laryngopharyngeal reflux (LPR) as suggested by the results of reflux symptom index (RSI > 13), reflux finding score (RFS > 7), and positive response to treatment with a 4-week course of proton-pump inhibitors.
2020: Pepsin as a biomarker of reflux in patients presenting at a UK ENT voice clinic
Overview: The aim of this study was to evaluate pepsin as a biomarker of reflux in symptomatic patients presenting at a secondary referral ENT voice clinic.
2020: Diagnostic Utility of Salivary Pepsin as Compared With 24-Hour Dual pH/Impedance Probe in Laryngopharyngeal Reflux
Overview: This study assesses the diagnostic utility of salivary pepsin (Peptest) at different thresholds and during symptomatic periods as compared with the 24h-HEMII-pH probe in diagnosing LPR.
2020: Pepsin as a Biomarker for Self-Diagnosing Reflux Associated Symptoms
Overview: The aim of the study was to show how pepsin can be used as a biomarker for reflux, using the noninvasive diagnostic Peptest for the self-diagnosis of reflux related symptoms.
2020: Tooth erosion and the role of pepsin reflux
Overview: The purpose of the study was to evaluate if there is a link between salivary pepsin levels and tooth erosion. Also, to determine if gastroesophageal reflux disease (GERD) is responsible for much of the tooth erosion seen by dentists.
2020: Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux
Overview: Laryngeal reflux (LPR) showed detectable levels of tear pepsin that explain the nasolacrimal obstruction. The purpose of this study was to determine whether patients with LPR show ocular surface changes and to investigate the relationship between lacrimal pepsin concentration and ocular alterations.
2019: Utility of Salivary Pepsin in Patients With Reflux Related Chronic Cough
Overview: La tos crónica (TC) asociada a reflujo es muy frecuente en la práctica clínica, pero su diagnóstico no siempre es sencillo. La determinación de pepsina en saliva es un método novedoso, sencillo y no invasivo para el estudio de reflujo
2019: Pepsin & Oropharyngeal pH Monitoring to Diagnose Patients With Laryngopharyngeal Reflux
Overview: The aim of this study was to compare the diagnostic accuracy of salivary pepsin with oropharyngeal pH monitoring using the Restech measurement system (Dx-pH) for the diagnosis of laryngopharyngeal reflux (LPR).
2019: Laryngopharyngeal Reflux (LPR)
Overview: Laryngopharyngeal reflux (LPR) can be defined as influx of stomach contents into the upper airway, especially the laryngopharynx and posterior nasopharynx. As a result, affected individuals complain of various laryngopharyngeal and respiratory symptoms caused by the damage to the upper airway epithelium. The aim of this chapter is to give a succinct overview of the current understanding of LPR.
2019: A pilot study demonstrating the evidence for reflux disease in patients presenting with non-allergic rhinitis (NAR)
Overview: To overcome the misdiagnosis of reflux disease and provide subjects with the appropriate treatment determine the link between non-allergic rhinitis (NAR) and reflux disease through analyzing pepsin concentration in patients presenting with NAR using the reflux diagnostic test, Peptest.
2018: Chronic pharyngitis and the association with pepsin detection and reflux disease
Overview: Pepsin is a biomarker for reflux disease and a major etiological factor in laryngopharyngeal reflux (LPR). Do chronic pharyngitis patients have significant concentrations of pepsin present in saliva samples indicating the presence of reflux disease?
2018: Pepsin: biomarker, mediator, and therapeutic target for reflux and aspiration
Overview: Extra-esophageal reflux is suspected to cause a wide range of clinical symptoms in the upper airways. Diagnosis and treatment has focused on acid, but realization of the role of nonacid reflux has resulted in research investigating the use of pepsin as a biomarker for gastric reflux and aspiration.
2018: Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018
Overview: The purpose of this article is to review the recent literature on clinical presentation, diagnosis and treatment and to propose a complete management algorithm of LPR.
2018: The Diagnostic Usefulness of the Salivary Pepsin Test in Symptomatic Laryngopharyngeal Reflux
Overview: The aim of the study was to determine the sensitivity, specificity, positive and negative Likelihood Ratio (LR) of the salivary pepsin assay (PEP-test, RD Biomed, Hull, UK) as diagnostic tool of LPR.
2018: The Upper Esophageal Sphincter Assist Device Is Associated With Symptom Response in Reflux-Associated Laryngeal Symptoms
Overview: This study aimed to assess the therapeutic efficacy of the upper esophageal sphincter assist device in a pragmatic clinical setting, and to identify factors associated with symptom response among patients with suspected Reflux-associated laryngeal symptoms.
2018: Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux
Overview: To evaluate the prediction value of saliva pepsin detection for an 8-week proton pump inhibitor (PPI) response in patients with a Reflux Symptoms Index (RSI) score 3, which indicates possible laryngopharyngeal reflux.
2018: Chronic pharyngitis and the association with pepsin detection and reflux disease
Overview: Pepsin is a biomarker for reflux disease and a major etiological factor in laryngopharyngeal reflux (LPR). Do chronic pharyngitis patients have significant concentrations of pepsin present in saliva samples indicating the presence of reflux disease?
2018: The Upper Esophageal Sphincter Assist Device Is Associated With Symptom Response in Reflux-Associated Laryngeal Symptoms
Overview: This study aimed to assess the therapeutic efficacy of the upper esophageal sphincter assist device in a pragmatic clinical setting, and to identify factors associated with symptom response among patients with suspected reflux-associated laryngeal symptoms.
2017: Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptest
Overview: The aim of the present study was to correlate the qualitativequantitative values of salivary pepsin (using PeptestTM) with symptoms and signs obtained from RSI and RFS. The final goal is to validate this enzyme immunoassay method using LPR diagnostic tools.
2017: Role of Pepsin and Oropharyngeal pH-Monitoring to Assess the Postoperative Outcome of Patients with Laryngopharyngeal Reflux: Results of a Pilot Trial
Overview: The aim of this study was to evaluate the value of salivary pepsin and oropharyngeal pHmonitoring to assess the surgical outcome of patients with laryngopharyngeal reflux (LPR).
2017: Laryngopharyngeal Reflux Disease – LPRD
Overview: This paper is written with the intention to assess the frequency of symptoms of LPR in family medicine, possible diagnostics and adequate treatment in primary health care.
2017: Salivary Pepsin Test: Useful and Simple Tool for the Laryngopharyngeal Reflux Diagnosis
Overview: The aim of the study is to describe the findings obtained by applying the salivary pepsin test in a sample of patients with the clinical suspicion of Laryngopharyngeal reflux (LPR)
2017: Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review
Overview: The objective of the present research is to analyze the existing literature using pepsin as a diagnostic tool of LPR through a systematic review of Laryngopharyngeal reflux (LPR)
2016: Laryngopharyngeal reflux: diagnosis, treatment and latest research
Overview: A review of the recent changes in understanding of laryngopharyngeal and extra-oesophageal reflux symptoms.
2016: The Role of Pepsin in LPR: Will It Change Our Diagnostic and Therapeutic Approach to the Disease?
Overview: Research is needed to elucidate the exact role that pepsin plays in inflammatory and neoplastic diseases of the laryngopharynx and to develop pharmacologic agents targeting pepsin.
2016: Association between 24-hour combined multichannel intraluminal impedance-pH monitoring and symptoms or quality of life in patients with laryngopharyngeal reflux
Overview: To evaluate the association between the parameters of 24-hour multichannel intraluminal impedance (MII)-pHmonitoring and the symptoms or quality of life (QoL) in laryngopharyngeal reflux (LPR) patients.
2015: Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest
Overview: The aim of the study was to investigate whether Peptest, an immunoassay used to detect pepsin, could be used to diagnose extraesophageal reflux (EER) in children with chronic otitis media with effusion (OME). The results obtained using this fast, simple and non-expensive method were compared with the results of previous studies.
2015: Salivary Pepsin Concentrations are Higher for Patients with Reflux Associated Laryngeal Symptoms: A Prospective Pilot Study
Overview: The aim of this study was to assess for differences in salivary pepsin for patients with LPR and gastroesophageal reflux disease (GERD) symptoms compared to controls.
2015: Salivary pepsin assay as a diagnostic test for laryngopharyngeal reflux
Overview: This study demonstrates that salivary pepsin assay has an excellent specificity and positive predictive value in diagnosing laryngopharyngeal reflux.
2015: Detecting laryngopharyngeal reflux in patients with upper airways symptoms: Symptoms, signs or salivary pepsin?
Overview: We compared symptoms, laryngeal signs and salivary pepsin as potential diagnostic methods for identifying LPR in patients with upper airway symptoms.
2015: Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux
Overview: To evaluate the accuracy of immunoserologic pepsin detection in the saliva for the diagnosis of LPR.
2014: Objective detection of esophagopharyngeal reflux in patients with hoarseness and endoscopic signs of laryngeal inflammation
Overview: This paper aimed to quantify pharyngeal exposure to gastric contents in patients diagnosed with reflux-related hoarseness and healthy controls using new diagnostic techniques.
2013: Pepsin detection despite the use of acid suppressant medication in patients with airway reflux related chronic cough
Overview: The following study assessed pepsin identification in chronic cough patients as a marker of airway reflux on proton pump inhibitor (PPI) medication.
2013: Laryngopharyngeal reflux and GERD
Overview: This paper on on laryngopharyngeal reflux includes commentaries on the use of patient-completed questionaires and anti-human pepsin antibodies and other non-invasive tests in diagnosis; the role of pepsin and acid in the etiologies of laryngeal cancers; and the application of proton pump inhibitor (PPI) therapy for the treatment of LPR.
2012: Do Patients With Hoarseness and Endoscopic Signs of LPR Have Abnormal Esophago-Pharyngeal Reflux?
Overview: It is proposed that hoarseness can be induced by abnormal exposure of the vocal cords to gastric contents. In these patients, laryngoscopy may show non-specific inflammatory signs, generally attributed to LPR. New methods are proposed to assess pharyngeal exposure to gastric contents.
2012: Novel Techniques For Assessing Oesophago-Pharyngeal Reflux in Patients
Overview: It is suggested that hoarseness along with typical signs on laryngoscopy can be caused by oesophagopharyngeal reflux, often referred to as LPR. New methods are proposed to assess pharyngeal exposure to gastric contents. They are suggested to measure 1) liquid or mixed gas-liquid acid and non-acid reflux (HMII-pH), 2) aerosolized acid reflux (Dx-pH measuring system, Restech), and 3) presence of pepsin in saliva. We aimed to quantify pharyngeal exposure to gastric contents in patients with hoarseness and healthy controls using the above techniques.
2012: New Developments in Extraesophageal Reflux Disease
Overview: This paper discusses recent developments in extraesophageal reflux disease with special emphasis on new diagnostic modalities and treatment options.
2012: Laryngopharyngeal pepsin reflux in patients with upper airway symptoms
Overview: We investigated: (a) the prevalence of pepsin reflux in respiratory patients requiring nasendoscopy for the investigation of upper airway symptoms; (b) the performance of commonly used clinical LPR-diagnostic tools in predicting the presence of salivary pepsin.
2011: Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication
Overview: 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.
2011: Laryngopharyngeal reflux-the ear, nose and throat patient
Overview: We investigated: (a) the prevalence of pepsin reflux in respiratory patients requiring nasendoscopy for the investigation of upper airway symptoms; (b) the performance of commonly used clinical LPR-diagnostic tools in predicting the presence of salivary pepsin.
2011: The prevalence of laryngopharyngeal reflux in the English population
Overview: Although symptoms of laryngopharyngealreflux (LPR) symptoms are commonly seen in the ENTclinic, their aetiology and prevalence in the population remain unknown.
2011: Review article: reflux and its consequences
Overview: The ‘Reflux and its consequences’ conference was held in Hull in 2010 and brought together a multidisciplinary group of experts all with a common interest in the many manifestations of reflux disease to present recent research and clinical progress in GERD and EERD.
2008: Use of a Non-Invasive Pepsin Diagnostic Test for Reflux: a series of case studies
Overview: A non-invasive diagnostic test in the form of a lateral flow test (LFT) specific for pepsin has been shown to be of benefit in the diagnosis of extraoesophageal reflux (EOR). This test is able to detect pepsin, as a marker of prior reflux, in the sputum of a patient, particular if experiencing symptoms.
2007: Evaluation of a non-invasive pepsin dipstick test for the diagnosis of extra-oesophageal reflux
Overview: Here we present data from a multi-centre pilot study the primary outcome of which was to establish whether a non-invasive in vitro test was capable of diagnosing patients with EOR by detection of the presence of gastric enzyme pepsin in sputum/saliva.
2007: Detection of pepsin using a non-invasive lateral flow test for the diagnosis of extra-oesophageal reflux
Overview: Diagnosis of extra-oesophageal reflux (EOR) remains difficult. 24hr pHmetry or impedance monitoring are invasive and insufficiently sensitive enough for use in EOR and the laryngoscopic signs of EOR can be non-specific. An objective, noninvasive test for the presence of EOR is warranted.
Gastroenterology
2021: Peptest and soft tissue lesions of the oral cavity
2021: Pepsin and pH of Gastric Juice in Patients With Gastrointestinal Reflux Disease and Subgroups
2021: Pepsin properties, structure, and its accurate measurement: a narrative review
2021: Association between gastroesophageal reflux disease and vocal fold polyps
2020: Pepsin as a biomarker for self-diagnosing reflux associated symptoms in UK and USA individuals
2020: Pepsin as a Biomarker for Self-Diagnosing Reflux Associated Symptoms
2020: The Association of Pepsin and Reflux in US Individuals Self-diagnosing their Reflux like Symptoms
2020: A narrative review of the prevalence of gastroesophageal reflux disease (GERD)
2020: Diagnostic performance of salivary pepsin for gastroesophageal reflux disease
Author(s):Rena Yadlapati, Alexander Kaizer, Madeline Greytak, Eze Ezekewe, Violette Simon, Sachin Wani
Overview: This study aimed to assess diagnostic performance of salivary pepsin, and test validity of thresholds in an external cohort of patients with or without GERD
2019: Salivary Pepsin for Diagnosis of Sub-types of Gastroesophageal Reflux Disease
2019: High prevalence of gastroesophageal reflux in vocal opera students. A case-control type study
2019: Clinical utility of salivary pepsin measurement in patients with proton pump inhibitor‑refractory gastroesophageal refux disease symptoms: a prospective comparative study
2019: Validation in China of a non-invasive salivary pepsin biomarker containing two unique human pepsin monoclonal antibodies to diagnose gastroesophageal reflux disease
2019: Extraoesophageal Reflux Manifestations of Gastro-oesophageal Reflux Disease
2017: Testing placement of gastric feeding tubes in infants
2017: The diagnostic value of pepsin detection in saliva for gastro-esophageal reflux disease: a preliminary study from China
2017: Salivary pepsin detection as a gastroesophageal reflux disease marker in pediatric population
2015: Optimisation of the Peptest diagnostic test for detection of GORD using pepsin as a marker
2015: Esophageal testing: What we have so far
2015: Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease
2015: Local Synthesis of Pepsin in Barrett's Esophagus and the Role of Pepsin in Esophageal Adenocarcinoma
2015: Does salivary pepsin measurement change diagnostic outcome in patients investigated by 24-pH monitoring?
2013: Pepsin in saliva and gastroesophageal reflux monitoring in healthy subjects and patients with heartburn/regurgitation
2012: Validation of peptest a new non-invasive technology for the diagnosis of LPR
2012: Rapid Salivary Pepsin Test: Blinded Assessment of Test Performance in Gastroesophageal Reflux Disease
2012: Use of a non-invasive pepsin diagnostic test to detect GERD
2010: Reflux and its Consequences - the Laryngeal, Pulmonary and Oesophageal Manifestations
Respiratory
2021: A narrative review of the potential role of microaspiration and a dysregulated aerodigestive microbiome in lung disease
2020:The Association of Pepsin and Reflux in US Individuals Self-diagnosing their Reflux like Symptoms.
2020: Pepsin as a Marker of Reflux Aspiration in Children With Esophageal Atresia: A Pilot Study
2020: Pepsin as a Marker of Reflux Aspiration in Children With Esophageal Atresia: A Pilot Study
2019: Using salivary pepsin and the reflux symptom index as objective markers of gastrooesophageal reflux to predict exacerbations of COPD
2018: Airway reflux: an emerging topic in respiratory medicine
2016: Bronchial reacutization and gastroesophageal reflux: is there a potential clinical correlation?
2015: Use of pepsin detection to identify airways reflux in a range of pulmonary diseases
2015: Detection of pepsin in sputum: a rapid and objective measure of airways reflux
2015: Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest
2014: Detection of pepsin as a marker of reflux in the coughed-up saliva samples of COPD patients.
2013: Pepsin detection in expectorated saliva: a useful marker for airway reflux?
2013: Pepsin as a biomarker of airway reflux in idiopathic pulmonary fibrosis - An observational study
Overview: Current understanding of IPF proposes repetitive pulmonary epithelial injury with aberrant healing as a principal mechanism. Gastro-oesophageal reflux (GOR) and micro-aspiration of gastric contents may cause lung injury with subsequent fibrosis. GOR is known to be prevalent in IPF patients. We assessed the feasibility of salivary pepsin measurement in IPF patients and investigated the temporal variability and relationship between salivary pepsin and symptoms.
2012: Pepsin detection despite the use of acid suppressant medication in patients with airway reflux related chronic cough
Author(s): Gemma L Crossfield, Warren Jackson, Jennifer Burke, Andrew D Woodcock, Vicki Strugala, Chris Ward, Jeffrey P Pearson, Peter W Dettmar, Alyn H Morice
2011: Reflux and asthma-mechanisms of interaction and asthma outcomes
2011: Reflux in cough and airway disease
2009: Detection of pepsin in sputum and exhaled breath condensate: could it be a useful marker for reflux-related respiratory disease?
Basic Science
2020: In vitro modelling of the mucosa of the oesophagus and upper digestive tract
2019: Damage to the Upper Gastrointestinal Tract - The Role of Pepsin
Overview: This review explores contemporary literature comprising of books, articles and conference presentations reporting on all roles of pepsin and the damage it can cause to the upper gastrointestinal tract.
2017: Pepsin and pH Levels of Human Gastric Juices in Gastroesophageal Reflux Disease Subgroups and Functional Heartburn.
Overview: The aim of this paper is to draw the key evidence together and to raise awareness of EER amongst gastroenterologists, who today are increasingly invited by ENT and respiratory specialists to help investigate patients in whom this condition is suspected.
2017: The characteristics of salivary pepsin in patients with severemotor and intellectual disabilities
Overview: The aim of the present study was to determine the utility of measuring the salivary pepsin level (SPL) as an objectiveassessment of gastroesophageal reflux disease (GERD) in severe motor and intellectual disabilities (SMID) patients.
2014: Chronic pepsin exposure promotes anchorage-independent growth, and migration of a hypopharyngeal squamous cell line
Overview: Hypopharyngeal squamous cell line chronically exposed to pepsin demonstrated increased cell migration, and colony forming ability relative to control cells. These experiments indicate that chronic pepsin exposure acts as a promoter of tumorigenesis and metastasis of airway epithelium, suggesting a role for pepsin in laryngopharyngeal carcinogenesis attributed to gastric reflux.
2012: Reflux Revisited - Advancing the Role of Pepsin
Overview: The aim of this paper is to draw the key evidence together and to raise awareness of EER amongst gastroenterologists, who today are increasingly invited by ENT and respiratory specialists to help investigate patients in whom this condition is suspected.
2011: Nature and properties of gastro-oesophageal and extra-oesophageal refluxate
Overview: Gastric juice contains many damaging agents against which the stomach has effective defences including a mucus bilayer which generates an unstirred layer which supports surface neutralisation of acid and forms a diffusion barrier to pepsin.
2011: Uptake of pepsin at pH 7 -in non-acid reflux- causes inflammatory, and perhaps even neoplastic, changes in the laryngopharynx.
Overview: Pepsin has been previously assumed to cause damage by its proteolytic activity alone, but our discovery that pepsin is taken up by laryngeal epithelial cells by receptormediated endocytosis opens the door to a new mechanism for cell damage, and downstream, the development of new therapies for reflux disease – receptor antagonists and ⁄ or pepsin inhibitors.
Peptest™ is a single use in-vitro diagnostic device not for ingestion. It conforms to the European Directive 98/79/EC on in-vitro Diagnostic Medical Devices; this is shown by the CE mark of conformity.
Peptest™ kits are manufactured in the UK by RDBiomed Limited - a private limited company registered in England and Wales with number 06979218.
RDBiomed Limited
Daisy Building (2nd Floor)
Castle Hill Hospital
Castle Road
Cottingham
HU16 5JQ, UK
VAT Number: GB 990 1918 96
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