The Diagnostic Value Of Pepsin Detection In Saliva For Gastroesophageal Reflux Disease

Objective The gold standard for the diagnosis of GERD has not reached a wide consensus.Pepsin in saliva has become a biological diagnostic marker for gastroesophageal reflux.This study is to perform quantitative analysis of pepsin content in saliva of GERD and to investigate the diagnostic value of saliva pepsin for gastroesophageal reflux disease,and to determine the optimal cut-off value for pepsin concentration contained in the saliva of normal humans.Methods 115 saliva specimens from patients suspected GERD above the age of 18 who visited the Gastroesophageal Reflux Center of the First Affiliated Hospital of Zhengzhou University from June 2017 to February 2018 were collected.The specimens were collected in fasting in the morning,1 hour after lunch,and when the related clinical symptoms appear,and nineteen patients with asymptomatic healthy persons of similar age and gender were treated as control group,whose specimens were collected in fasting in the morning,1 hour after lunch.All patients in the case group underwent Gerd Q questionnaire,24-hour mii-ph monitoring and endoscopy.All patients receied the PPI test,i.e.,oral esomeprazole 20mg/ time,2 times/day for 2 weeks.According to endoscopic esophagus multichannel joint 24 hours cavity impedance-p H(MII-p H)monitoring results,patients were incorporated in the divided into gastroesophageal reflux disease(GERD)group,gastroesophageal reflux disease(GERD)group and the control group.That is,The patients who met gastroesophageal reflux disease by reflux esophagitis or 24-hour esophageal MII-p H monitoring results were GERD group,otherwise they were non-GERD group.Asymptomatic healthy volunteers were included as controls,otherwise they were non-GERD group.Asymptomatic healthy volunteers were included as controls.Results(1)The positive rate and pepsin concentration in GERD group were higher than those in the non-gerd group and the healthy control group(P< 0.05).(2)In patients with GERD group and non GERD symptoms occur and lunch after 1 hour and pepsin concentration in saliva samples and pepsin detection positive rate of morning rises high with significant difference(P<0.05).There was no significant difference between the gastric protease concentration and the positive rate of pepsin in the saliva samples collected after fasting and meal in the control group(P>0.05).(3)When the critical value of pepsin concentration was 91.92 pg/ml,the sensitivity and specificity of gastric protease concentration were 74.2% and 88.7% respectively.(4)By MII-24 hours p H monitoring and endoscopy results for diagnosis of GERD positive standard,saliva pepsin,when you pick up the critical value of 91.92 pg/ml for GERD diagnostic sensitivity,specificity,positive predictive value,negative predictive value of 82.0%,69.0%,75.9% and 76.3% respectively.The sensitivity,specificity,positive predictive value and negative predictive value of PPI diagnostic test were 72.0%,45.2%,61.0% and 57.5% respectively.When the critical value of Gerd Q scale was 8,the sensitivity,specificity,positive predictive value and negative predictive value of GERD diagnosis were 62.0%,52.4%,60.8% and 53.7 %.ConclusionQuantitative detection of pepsin in saliva can be used as a rapid,simple,effective and non-invasive method to diagnose GERD.The quantitative detection of pepsin in saliva has a certain value in the diagnosis and differential diagnosis of GERD.This method has broad prospects and might replace the current invasive tests(endoscopy or MII-PH monitoring).