The Relationship Between Laryngopharyngeal Reflux And Difficult-to-treat Rhinosinusitis

Objectives:The paper aims to explore the correlation between laryngopharyngeal reflux and difficult-to-treat rhinosinusitis by testing the concentration of pepsin in saliva of patients,enrich the etiology and pathogenic factors of difficult-to-treat rhinosinusitis,provide new ideas for the standardized diagnosis and treatment of difficult-to-treat rhinosinusitis,investigate the application value of salivary pepsin detection in the diagnosis of laryngopharyngeal reflux and compare the difference between the two methods.Through comparison for the differences between the two pepsin detection methods,a convenient and reliable pepsin detection method for LPR-related DTRS was found.Methods:80 patients who planned to undergo endoscopy sinus surgery(EES)treatment were selected as the research objects,including 40 patients with difficult-to treat rhinosinusitis(DTRS group)and 40 patients with chronic rhinosinusitis(CRS group).These patients were hospitalized in the Otolaryngology Department of our hospital from May 1,2018 to November 30,2019,who met the diagnostic criteria and voluntarily participated in this clinical study.After admission,saliva samples were collected from the two groups of patients on fasting in the morning,1 hour after lunch,1 hour after dinner,and within 15 minutes of reflux symptoms.Using PeptestTM pepsin detection kit(RD Biomed Limited)to detect the pepsin concentration of saliva samples from two groups at different sampling times.Meanwhile,using Enzyme linked immunosorbent assay(ELISA)to detect pepsin in the morning fasting saliva samples of the two groups.And then,relevant clinical examination and score were conducted,including the reflux symptom index(RSI),reflux finding score(RFS),endoscopy and laryngoscopy and sinus CT.The test results were statistically analyzed,and the score differences in pepsin concentration,RSI and RFS between the DTRS group and the CRS group were analyzed by the independent sample t.The correlation between laryngopharyngeal reflux parameters(pepsin concentration,RSI and RFS score)and sinusitis parameters(Lund-Kennedy endoscop sinus,Lund-Mackay CT score,SNOT-22 score)was evaluated by perason correlation analysis.The two methods of ELISA and Peptest were used to detect pepsin and RSI combined with RFS,and the ROC curves were prepared respectively,to further evaluate the diagnostic efficacy of this indicator for LPR.SPSS 25.0 statistical software was used for statistical analysis of all the above data,and p<0.05 is considered statistically significant.Results:The average score of RFS in DTRS group was 7.05 ± 1.96,and the average score of RSI was 14.38 ± 8.59;The average score of RFS in CRS group was 4.55 ±2.36,and the average score of RSI was 7.7 ± 3.29.As the scores of RSI and RFS in DTRS group were significantly higher In the CRS group,so the difference was statistically significant(p<0.001).According the ELISA detection,the average value of moring fasting saliva pepsin concentration in the DTRS group was 318.06±84.19 ng/ml,and the CRS group was 71.57±35.93 ng/ml.The average level of salivary pepsin in DTRS group is significantly higher than that in CRS group,the difference is statistically significant(p=0.003).According to Peptest,the average level of salivary pepsin in the DTRS group is higher than that in the CRS group at four different sampling times,with fasting in the morning(140.01±61.81 ng/ml vs 112 ±35.14 ng/ml,p<0.05),1h after lunch(207.15±117.39 ng/ml vs 76.39±65.03 ng/ml,p<0.001),1h after dinner(276.70 ± 103.27 ng/ml vs 206.24 ± 106.24 ng/ml,p=0.004),and 1 time reflux finding(298.03 ± 100.89 ng/ml vs 214.84 ± 96.17ng/ml,p<0.001),the difference is statistically significant.Pearson correlation analysis showed that RSI and RFS have medium to high positive correlation with Lung-Kennedy nasal endoscopy score,Lung-Mackay CT score and SNOT-22 score.The pepsin concentration detected by ELISA and Peptest has low to medium positive correlation with Lung-Kennedy endoscop sinus score,Lung-Mackay CT score and SNOT-22 score.The Area Under Curve(AUC)of LPR obtained by ELISA and Peptest were higher than that of RSI combined with RFS(0.864,0.702,0.622,respectively).Conclusion:1.There may be a correlation between laryngopharyngeal reflux and difficult-to treat rhinosinusitis.Pepsin in reflux may be one of the relative risk factors for difficult-to treat rhinosinusitis,which plays an important role in the pathogenesis and development of DTRS.2.In the ELISA and Peptest for saliva pepsin,the diagnostic efficacy of LPR is higher than that of RSI combined with RFS.3.Compared with ELISA,the specificity of Peptest is relatively low,but the sensitivity is better,and Peptest is more convenient,economical,and more suitable for clinical diagnosis and large-scale study.