July 16, 2013

Rapid Saliva Test to Look for Laryngopharyngeal Reflux

When you compare a spit test to the current way of how throat level reflux (LPR) is determined via barium swallow, upper endoscopy (EGD), and 24 hour ph/impedance testing, it sounds quite attractive.

How does such a test work?

It basically looks for a stomach protein called pepsin.

Given reflux is when stomach contents moves up towards the mouth and pepsin is a protein ONLY produced in the stomach... pepsin should NOT be found in the throat/mouth. 

As such, the test can state "yes" or "no" whether LPR is present or not. Keep in mind that this test does NOT inform what type of reflux is present whether acid reflux or non-acid reflux, nor does it reliably inform how severe the reflux is.  Only the 24 hour ph/impedance testing can provide such information.

That said, research suggests a nearly 90% correlation between a positive salivary pepsin test and 24 hour ph/impedance test.

The steps to the test are as follows:


How good is the test?

Depending on the study, sensitivity ranges in the 80-100% (can actually detect reflux if truly present) and specificity is around 85% (truly no reflux if test is negative).

The original test company is RDbiomed (in Europe) using their Peptest kit.

The other is PepsinCheck here in the United States.

This test is currently not FDA approved yet and as such, is a test that is NOT covered by insurance at this time.

Results are typically obtained within one week after the kit is sent back to the lab.

You can order this test yourself online as an individual. It is recommended you take the standard 3 sample test kit.

Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux. Laryngoscope. 2005 Aug;115(8):1473-8.

Rapid salivary pepsin test: Blinded assessment of test performance in gastroesophageal reflux disease. Laryngoscope. 2012 Jun;122(6):1312-6. doi: 10.1002/lary.23252. Epub 2012 Mar 23.

Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review. Otolaryngol Head Neck Surg. 2017 Sep;157(3):385-391. doi: 10.1177/0194599817709430. Epub 2017 Jun 6.

The Diagnostic Usefullness of the Salivary Pepsin Test in Symptomatic Laryngopharyngeal Reflux. J Voice. 2018 Oct 9. pii: S0892-1997(18)30081-X. doi: 10.1016/j.jvoice.2018.07.008. [Epub ahead of print]

Pepsin and oropharyngeal pH monitoring to diagnose patients with laryngopharyngeal reflux. Laryngoscope. 2019 Oct 11. doi: 10.1002/lary.28320. [Epub ahead of print]

Diagnostic Utility of Salivary Pepsin as Compared With 24-Hour Dual pH/Impedance Probe in Laryngopharyngeal Reflux. Volume: 164 issue: 2, page(s): 375-380.

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Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


Unknown said...

Dr. Chang,
Can you recommend any doctors specalizing in LPR or GERD in the South Bend, IN or Chicago, IL area. I have been suffering from the symptoms of LPR for awhile and haven't found any relief from my current ENT yet.

Fauquier ENT said...

Given we are located in Virginia, I would suggest you ask your local ENT for appropriate referral in Indiana.

Anonymous said...

Dr Chang, can you use this spit Peptest kit for diagnosing other types of reflux eg GERD?

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