Pepsin Detection In Esophageal Reflux For The Diagnosis Of Gastro-esophageal Reflux Disease

ObjectivePepsin in esophageal reflux has been posited to be a reliable biological markerof reflux disease. We quantitative analysis pepsin in esophageal reflux collected inpatients with reflux and heartburn. Aimed to(1) identify the value of pepsin in refluxfor the diagnosis and differential diagnosis of gastro-esophageal reflux disease,(2)compare the sensitivity/specificity of pepsin detection in esophageal reflux withMII-pH/PPI test/GerdQ,(3) evaluate its predictive value of PPI test.Design154patients with the symptoms of heartburn and reflux accept GerdQ and154patients and21controls underwent MII-pH and collect the esophageal reflux onwaking, after lunch and dinner.133Patients who finished MII-pH and pepsincollection received20mg of esomeprazole twice a day for2weeks, and werepresented with a6-item GerdQ in addition. Patients were divided intoGERD(increased acid exposure time (AET), n=67); HO (normal AET and+Symptom Association Probability (SAP), n=34) and FH (normal AET and-SAP,n=32).Results(1)Patients with GERD and HO had higher prevalence and pepsin concentrationthan FH.(2) Pepsin was significantly more likely to be detected in the postprandialperiod and the concentration was always higher than the waking samples.(3).Basedon MII-pH data, one positive sample with>36.41ng/mL pepsin had73.0%sensitivity and69.7%specificity for diagnosis of GERD.(4)Compared with MII-pH，the sensitivity, specificity, positive predictive value, negative predictive value ofpepsin in reflux are71.7%,84.7%,82.7%,74.6;83.3%,49.2%,62.5%,74.4%forPPI test;65.0%,45.8%,54.9%,56.3%for GerdQ.(5)The sensitivity/specificity ofpepsin in reflux is58.2%,85%compared with PPI test. ConclusionPepsin in reflux provide a new non-invasive method for diagnosing GERD, italso has its value to discriminate patients with GERD from functional heartburn.Pepsin in reflux has superiority with specificity and positive predictive valuecompared with MII-pH, especially with GerdQ/PPI test. Pepsin in reflux canevaluate the result of PPI test.