Pepsin detection in the sputum/saliva for the diagnosis of gastroesophageal reflux disease in patients with clinically suspected atypical gastroesophageal reflux disease symptoms

Background/Aims: Atypical manifestations of gastroesophageal reflux disease (GERD) are diverse. We aimed to determine whether pepsin detection in the sputum/saliva could be useful for diagnosing GERD in patients with clinically suspected atypical GERD symptoms. Methods: Patients with clinically suspected atypical GERD symptoms provided sputum/saliva collected before bedtime, at the time of those symptoms, and after awakening for pepsin measurement by Western blot analysis. All subjects received 24-hour esophageal pH monitoring, and then 40 mg of esomeprazole was given twice a day for 2 weeks. Results: The pepsin test was positive in 20 out of 40 patients, with pepsin detected mainly in the samples collected at the time of symptoms (45%). Samples collected from healthy volunteers (n = 8) were all negative for pepsin. 24-hour pH-metry was positive in 9 patients (23%). Based on 24-hour pH-metry data, the sensitivity and negative predictive value of the pepsin test were excellent in most of typical and atypical symptom groups, whereas its specificity and positive predictive value were relatively low, particularly in atypical symptom groups. Conclusions: Pepsin measurement in the sputum/saliva collected at the time of symptoms provides a sensitive, non-invasive method for diagnosing GERD in patients with clinically suspected atypical GERD symptoms. Copyright c 2008 S. Karger AG, Basel.