Rapid testing for pepsin

The Peptest kit is an immunological in-vitro diagnostic medical device that contains two pepsin monoclonal antibodies; it allows you to identify pepsin in a clinical sample of saliva/ sputum quickly and easily.

No specific training is required to use Peptest but it is designed for use by healthcare professionals.

You can order Peptest kits for use at your facility and we also invite researchers to our laboratory for pepsin diagnostics.

Peptest conforms to the European Directive 98/79/EC on in-vitro Diagnostic Medical Devices, which is shown by the CE mark of conformity.

People using Peptest

GABRIEL HENDOW
GP at Bransholme Health Centre and an ENT specialist
Read Case Study

PROF. KARNA DEV BARDHAN
Consultant Gastroenterologist at Rotherham General Hospital
Read Case Study

MR MARK WATSON
Consultant ENT Surgeon
Read Case Study

PROF. ALYN H. MORICE
Head of Cardio & Respiratory Studies at University of Hull
Read Case Study

Peptest is fantastic to use because its simplicity means I do not have to refer my patient to secondary care.

Dr Gabriel Hendow

I would definitely recommend using Peptest and I think it will become widely used.

Prof. Karna Dev Bardhan

I give talks and lectures on laryngopharyngeal reflux and I try to make people aware of Peptest

Mr Mark Watson

Because it is such a rapid test we are able to receive the results while I am seeing the patient in the clinic

Prof. Alyn Morice

Find your local distributor

RESEARCH PAPERS

Basic Science

2012: Assessment of the potential of a novel detection method for measuring pepsin as a biomarker of reflux

Author(s): Iain A. Brownlee1 , Andrew Woodcock2 , Chi Zhang3 , Siqing Li3 , Jeffrey P. Pearson4 , Peter W. Dettmar2

Overview: Clinical assessment of gastric reflux occurrence (by intraluminal impedance or pHmetry) is well-validated. However, such measurements techniques are invasive and timeconsuming. They may also not allow for assessment of extra-oesophageal reflux by aerosolisation or microaspiration. Pepsin is a proteolytic enzyme secreted by the stomach.

Open and Download research paper

2011: Nature and properties of gastro-oesophageal and extra-oesophageal refluxate

Author(s): J. P. Pearson & S. Parikh

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.

Open and Download research paper

2008: Pepsin - the aggressor

Author(s): Dettmar & Strugala

Overview :Extra-esophageal Reflux Disease The Future: Diagnosis and Treatment in conjunction with the 8 th International Symposium on Human Pepsin

Open and Download research paper

2006: Production and characterisation of monoclonal antibodies to human pepsin

Author(s): Dettmar & Strugala

Overview: Monoclonal antibody technology produces antibodies with high specificity of binding to the target antigen, homogeneity of the preparation and can be produced in unlimited quantities. These are qualities that are necessary for the development of a clinically useful reproducible diagnostic test. In addition, they enable a lateral flow test format (dipstick) to be developed. Here we discuss the production of two monoclonal antibodies (mAb) to human pepsin 3 and the characterisation of the resulting ELISA system.

Open and Download research paper

2005: Effects of centrifugation on human saliva samples

Author(s): Farndale, A.J., Dettmar, P.W., Strugala V

Overview: Reflux of gastric contents is a causative factor in conditions such as chronic cough and Laryngopharyngeal Reflux. Currently the “gold standard” for diagnosis of reflux disease is 24 hour pH monitoring, an invasive technique which affects patient lifestyle and reflux frequency. However, pepsin is the major damaging agent within the gastric refluxate (1-2) and so it is more appropriate to use this as a marker for reflux than acid. Here we present improvements in a novel, non-invasive, diagnostic test for reflux disease using pepsin as the marker in sputum/saliva samples.

Open and Download research paper

2012: Reflux Revisited - Advancing the Role of Pepsin

Authors: Bardhan, Strugala, and Dettmar

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.

Open and Download research paper

2011: Uptake of pepsin at pH 7 -in non-acid reflux- causes inflammatory, and perhaps even neoplastic, changes in the laryngopharynx.

Author(s): N. Johnston

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.

Open and Download research paper

2007: Detection of pepsin after longitudinal sampling of sputum from patients with extra-oesophageal reflux disease

Author(s): Strugala, Printza, Dettmar

Overview: The detection of pepsin in clinical samples can be used as a marker of reflux of gastric contents. Pepsin has been detected in middle ear effusions, bronchoalveolar lavage fluid , laryngeal biopsy tissue and sputum . We have demonstrated pepsin in sputum samples from patients with extra-oesophageal reflux (EOR) and that diagnostic yield is enhanced when the sample was provided when the patient was symptomatic.

Open and Download research paper

2005: Diagnosis of Reflux Disease using Pepsin as a Marker

Author(s): Strugala, Farndale, Jacob, Dettmar

Overview: The aim of this project is to develop a range of non-invasive, commercially viable, diagnostic tests for reflux disease. These tests will detect pepsin, a more appropriate marker for reflux disease than pH.

Open and Download research paper

Ears, Nose and Throat (ENT)

2015: Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest

Author(s): Martin Formanek, Karol Zelenık, Pavel Komınek, Petr Matousek

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.

Open and Download research paper

2012: Do Patients With Hoarseness and Endoscopic Signs of LPR Have Abnormal Esophago-Pharyngeal Reflux?

Author(s): Jamal O. Hayat, Jin-Yong Kang, Peter W. Dettmar, Andrew T. Moore, Lucy C. Hicklin, Etsuro Yazaki, Daniel Sifrim

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.

Open and Download research paper

2011: Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication

Author(s): Eelco Wassenaar, Nikki Johnston, Albert Merati, Martin Montenovo, Rebecca Petersen, Roger Tatum, Carlos Pellegrini, Brant Oelschlager

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.

Open and Download research paper

2008: Use of a Non-Invasive Pepsin Diagnostic Test for Reflux: a series of case studies

Author(s): Strugala, McGlashan, Morice, Dettmar

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.

Open and Download research paper

2007: Evaluation of a non-invasive pepsin dipstick test for the diagnosis of extra-oesophageal reflux

Author(s): Strugala, McGlashan, Watson, Morice, Calderone, Dettmar

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.

Open and Download research paper

2012: Novel Techniques For Assessing Oesophago-Pharyngeal Reflux in Patients

Author(s): J. O. Hayat, E. Yazaki, A. T. Moore, L. A. C. Hicklin, P. W. Dettmar, J.-Y. Kang, D. Sifrim

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.

Open and Download research paper

2012: Laryngopharyngeal pepsin reflux in patients with upper airway symptoms

Author(s): A Spyridoulias, S Lillie, A Vyas, SJ Fowler

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.

Open and Download research paper

2011: Laryngopharyngeal reflux-the ear, nose and throat patient

Author(s): M Watson

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.

Open and Download research paper

2007: Detection of pepsin using a non-invasive lateral flow test for the diagnosis of extra-oesophageal reflux

Author(s): Strugala, McGlashan, Watson, Morice, Granier, Dettmar

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.

Open and Download research paper

2006: Pepsin detection for the diagnosis of Extra-oesophageal Reflux

Author(s): Strugala, McGlashan, Morice, Watson, Dettmar

Overview: Diagnosis of extra-oesophageal reflux (EOR) follows the same well established method used for gastro-oesophageal reflux disease of ambulatory dual probe 24 hour pH monitoring (pHmetry) albeit with the upper probe being placed above the upper oesophageal sphincter in the larynx. A new diagnostic method for EOR is clearly warranted.

Open and Download research paper

Gastroenterology

2014: Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease

Author(s): Jamal Hayat, Shirley Gabieta-Somnez, Etsuro Yazaki, Jin-Yong Kang, Andrew Woodcock, Peter Dettmar, Jerry Mabary, Charles H Knowles, Daniel Sifrim

Overview: The aims of this study were to establish normal values of salivary pepsin in healthy asymptomatic subjects and to determine its value to discriminate patients with refluxrelated symptoms (GORD, hypersensitive oesophagus (HO)) from functional heartburn (FH).

Open and Download research paper

2012: Rapid Salivary Pepsin Test: Blinded Assessment of Test Performance in Gastroesophageal Reflux Disease

Author(s): Elif Saritas Yuksel, MD; Shih-Kuang S. Hong, MD, MSCI; Vicki Strugala, PhD; James C. Slaughter, DrPH; Marion Goutte, BS; C. Gaelyn Garrett, MD; Peter W. Dettmar, PhD; Michael F. Vaezi, MD, PhD

Overview: Pepsin lateral flow device (LFD) is a rapid noninvasive test to detect salivary pepsin as a surrogate marker for gastroesophageal reflux disease (GERD). We aimed to establish the test sensitivity, specificity, positive and negative predictive values (PPV, NPV) in patients with symptomatic and objective evidence of GERD compared to healthy controls.

Open and Download research paper

2012: Validation of peptest a new non-invasive technology for the diagnosis of LPR

Author(s): Bor, Capanoglu, Yildirim, Vardar, Woodcock, Dettmar

Overview: The study was designed to validate the reliability of a non-invasive lateral flow device (LFD) PeptestTM for pepsin determination following reflux symptoms during intraesophageal impedance measurement (MII-pH)

Open and Download research paper

2013: Pepsin in saliva and gastroesophageal reflux monitoring in healthy subjects and patients with heartburn/regurgitation

Author(s): Hayat, Gabieta-Gomez, Yazaki, Kang, Woodcock, Dettmar, Mabary, Sifrim

Overview: The aim of this study was to measure pepsin in saliva with objective assessment of GOR by impedance-pH (MII-pH) in a cohort of asymptomatic subjects and consecutive patients with clinically significant heartburn (according to the Montreal definition of GORD).

Open and Download research paper

2012: Use of a non-invasive pepsin diagnostic test to detect GERD

Author(s): Bortoli, Savarino et al

Overview: The aim was to evaluate the accuracy of PEP-Test in diagnosing GERD using MII-pH monitoring as reference standard

Open and Download research paper

2010: Reflux and its Consequences - the Laryngeal, Pulmonary and Oesophageal Manifestations

Author(s): P. W. Dettmar, D. O. Castell and R. C. Heading

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. In particular new techniques for diagnosing reflux were showcased at the conference.

Open and Download research paper

Respiratory

2013: Pepsin detection in expectorated saliva: a useful marker for airway reflux?

Author(s): Shoaib Faruqi, Andrew D. Woodcock, Peter W. Dettmar, Alyn H. Morice

Overview:  The presence of pepsin in the oesophagus, or more proximally in the pharynx or the airways, suggest GOR. The aim of this study was to study the diagnostic utility of measuring pepsin in expectorated saliva in unselected patients presenting with chronic cough.

Open and Download research paper

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

Overview: Airway reflux is a common cause of unexplained chronic cough and proton pump inhibitor (PPI) medication is commonly prescribed as initial therapy. The following study assessed pepsin identification in Chronic Cough patients as a marker of airway reflux on PPI.

Open and Download research paper

2011: Reflux and asthma-mechanisms of interaction and asthma outcomes

Author(s): S. M. Harding

Overview: Oesophageal contents can alter lung function and impact airway inflammation. Reflux treatment improves asthma outcomes in selected asthmatics.

Open and Download research paper

2013: Pepsin as a biomarker of airway reflux in idiopathic pulmonary fibrosis - An observational study

Author(s): Dudziak, Crooks, Woodcock, Dettmar, Morice, Hart

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.

Open and Download research paper

2011: Reflux in cough and airway disease

Author(s): A H Morice

Overview: A new technology, including airway pH and exhaled breath condensate pepsin levels provide supporting evidence for the hypothesis that chronic cough is really a single diagnosis which has been termed the cough hypersensitivity syndrome.

Open and Download research paper

2009: Detection of pepsin in sputum and exhaled breath condensate: could it be a useful marker for reflux-related respiratory disease?

Author(s): Strugala,  Faruqi, Dettmar, Morice

Overview: We present data utilising sputum/saliva or exhaled breath condensate (EBC) of patients with chronic cough with and without recent symptoms.

Open and Download research paper