Measuring salivary pepsin levels has the potential to reduce time to diagnose acid reflux, minimise the use of proton pump inhibitor (PPI) therapy, and streamline care for patients with symptoms.

That’s the findings of a new study undertaken at two care centres at the University of Colorado and the University of California San Diego.

Currently, gastro-oesophageal reflux disease (GORD/GERD) is clinically diagnosed based on patient report of troublesome oesophageal symptoms, such as heartburn, regurgitation, and chest pain.

The management for patients with symptoms of GERD typically relies on empiric – ‘educated guess’ – trials of proton pump inhibitor (PPI) therapy.

Yet, almost half of patients with symptoms suggestive of GERD do not derive adequate symptom relief from the medication. While, walk-in reflux monitoring ultimately uncovers normal findings, or absence of GERD, in a majority of PPI non-responders.

In the ‘Diagnostic Performance Of Salivary Pepsin For Gastroesophageal Reflux Disease’ study – recently published in the Diseases of the Esophagus journal – researchers enrolled adult asymptomatic volunteers, patients with symptoms of GERD undergoing reflux monitoring, and patients with Barrett’s oesophagus.

Fasting saliva samples were processed for pepsin concentration using Peptest.

Researchers found that salivary pepsin concentrations were significantly higher for GERD compared to no GERD subjects. Among the no GERD subjects, mean pepsin concentrations were similar between healthy volunteers and those with functional heartburn. (Note: Functional heartburn is characterised by episodes of burning discomfort in the chest but with no evidence of inflammation in the lining of the oesophagus).

The study suggests that a risk prediction model inclusive of salivary pepsin and clinical data could predict GERD with high diagnostic performance.

The study’s conclusion:

  • Measurement of salivary pepsin using Peptest has several attributes of an optimal diagnostic tool
  • It is already well known to be affordable, rapid in time to diagnosis, non-invasive, and easy to administer
  • Our prospective study importantly highlights and validates the performance characteristics of salivary pepsin, particularly sensitivity of 86% at a threshold of 24.9 ng/mL. A salivary pepsin level of 24.9 ng/ml optimised the true negative rate of GERD with a sensitivity of 71% and specificity of 67%. Salivary pepsin levels greater than 100 ng/ml optimized the true positive rate of GERD with 93% specificity.
  • Implications of salivary pepsin measurement have potential to reduce time to diagnosis, minimise empiric and often ineffective PPI therapy, and streamline care for patients with GERD symptoms
  • With further research clarifying the clinical role of salivary pepsin, one can envision a screening role of salivary pepsin using Peptest in a primary care or specialty care setting for patients presenting with suspected GERD in which patients with low salivary pepsin levels may represent a group with low likelihood of GERD.
  • For these patients a PPI trial may not be needed, and rather a focus on alternative etiologies of symptoms could be considered.

 

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