Pepsin in saliva for the diagnosis of erosive esophagitis post-sleeve gastrectomy: a prospective observational study

BackgroundLaparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, new onset erosive esophagitis (EE) is a major shortcoming. Current recommendation is esophago-gastro-duodenoscopy (EGD) should be performed routinely at 1 year and subsequently every 2-3 years to enable the early detection of Barrett's or esophageal adenocarcinoma. This would put significant strains on resources and costs of bariatric program. Our study assesses the association between and diagnostic value of salivary pepsin concentration and endoscopically proven EE in post-LSG patients as a surrogate for EGD.MethodsTwenty patients on routine post-LSG endoscopy between June and September 2022 were recruited for this correlational pilot study. Under supervision, fasting and post-prandial saliva sample was collected and analyzed by Peptest lateral flow device. EGD examinations were performed, and patients completed a validated 25-item QoLRAD questionnaire.ResultsWe found a significant correlation between positive endoscopy findings of EE and salivary pepsin concentrations. The normal group had a lower mean fasting pepsin level (13.13 ng/mL +/- 18.97) versus the EE-group (90.55 ng/mL +/- 81.28, p = 0.009) and lower mean post-prandial pepsin level (30.50 ng/mL +/- 57.72) versus the EE-group (135.09 ng/mL +/- 130.17, p = 0.02). The predictive probabilities from the binary regression of fasting and post-prandial pepsin concentrations yield AUC of 0.955 +/- 0.044 (95% CI 0.868 to 1.000, p < 0.001).ConclusionOur study distinctively identified salivary pepsin to have excellent sensitivity and negative predictive value in EE, potentially useful to preclude the need for post-LSG EGD in asymptomatic patients with low salivary pepsin.

Automated summary

The study found a significant correlation between salivary pepsin concentrations and erosive esophagitis (EE), indicating that it may serve as a useful indicator to determine whether asymptomatic patients with low salivary pepsin require esophago-gastro-duodenoscopy (EGD) after laparoscopic sleeve gastrectomy (LSG) to detect any potential complications.