A diagnosis of laryngopharyngeal reflux (LPR) can be made on the basis of characteristic symptoms and nasendoscopy findings. Objective tests exist for this condition; for example, 24-hour dual-channel pH-metry which is considered to be the gold standard. Such tests are, however, limited by their cost and invasiveness. Testing for pepsin in saliva is a non-invasive method that has the potential to aid the diagnosis of LPR in an objective and cost-effective fashion. The PEP-test is an immunological in vitro method which detects pepsin in saliva at a concentration equal to or greater than 16ng/ml. This paper reports on the specificity and sensitivity of the PEP-test in 221 subjects. It is claimed that a fasting PEP-test has a 98% specificity and 40% sensitivity for LPR. In other words, a positive result can be considered diagnostic for LPR but a negative result has a high chance of being falsely negative and more complex tests should be considered if the clinical suspicion for LPR remains high. Whilst a plausible and conceptually appealing result, this paper is limited by the fact that a ‘true’ diagnosis of LPR (and the benchmark against which the PEP-test was measured) was considered to be a reflux symptom index score of greater than 13. The results presented would have been more convincing if the accuracy of the PEP-test was compared to existing objective assessments such as oesophageal pH testing. Nevertheless, the PEP-test does appear to represent a useful non-invasive bedside test for laryngopharyngeal reflux that appeals because it requires nothing more from a patient than a sample of saliva.
Salivary pepsin – a simple test for LPR?
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