July 16, 2013

We Now Offer 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.

And we are one of the very few offices in the United States that offer this spit test. Even major laboratory companies like Labcorp and Quest do not offer this test yet.

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.

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).

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

This test is currently not FDA approved yet and as such, is a test that is NOT covered by insurance at this time. Due to a special arrangement our office has with RDBiomed, the Peptest kit can be obtained in our office at a discounted price of $125 (compared to normal price of $175). Price includes the kit, test supplies, and courier shipping service.

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

Please note that this testing is ONLY offered to current patients of ours.

However, if you are not a current patient of ours, you can order this test yourself online as an individual without a visit to our office. It is recommended you take the standard 3 sample peptest. Click here for more information.

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]
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. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.


Josh Jusko 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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