J Neurogastroenterol Motil  https://doi.org/10.5056/jnm19032
Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders
Yan-Jun Wang,1 Xiu-Qiong Lang,1 Dan Wu,1 Yu-Qin He,1 Chun-Hui Lan,1 Xiao-Xiao,1 Bin Wang,1 Duo-Wu Zou,2 Ji-Min Wu,3 Yong-Bin Zhao,4 Peter W Dettmar,5 Dong-Feng Chen,1and Min Yang1*
1Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, ArmyMedical University, Chongqing, China; 2Department of Gastroenterology, Ruijin Hospital,School of Medicine, Shanghai Jiaotong University, Shanghai, China; 3Department ofGastroenterology, Department of Gastroesophageal Reflux Disease, PLA Rocket ForceGeneral Hospital, Beijing, China; 4Department of Gastroenterology, Xinqiao Hospital,Chongqing, China; and 5RD Biomed Limited, Castle Hill Hospital, Cottingham, UK
Correspondence to: Min Yang and Dong-Feng Chen are equally responsible for this study.
Min Yang, MD, PhD
Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army MedicalUniversity, 10 Changjiang Branch Road, Daping, Chongqing 400042,China
Tel: +86-23-68757751, Fax: +86-23-68757750, E-mail: yangmindoctor@126.comDong-Feng Chen, MD, PhD
Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army MedicalUniversity, 10 Changjiang Branch Road, Daping, Chongqing 400042,China
Received: February 13, 2019; Revised: June 14, 2019; Accepted: July 23, 2019; Published online: October 25, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
To determine the value of salivary pepsin in discriminating sub-types of gastroesophageal refluxdisease (GERD) and GERD-related disorders.
Methods
Overall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) werestudied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) andunderwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsinconcentration (SPC) was detected by using colloidal gold double-antibody immunologicalsandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosivereflux disease (NERD) and extra-esophageal symptoms (EES).
Results
Compared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERDsymptoms, or Barrett's esophagus had a higher prevalence of saliva and SPC (all P < 0.001).There was no significant difference in the positive rate for pepsin in patients with functionalheartburn or GERD with anxiety and depression, compared to HC. After esomeprazoletreatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) andin EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) werepositive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) ofpathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002).
Conclusions
Salivary pepsin has an important significance for the diagnosis of GERD and GERD-relateddisorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with eachother to improve the diagnostic efficiency.
Keywords: Anxiety, Esophageal pH monitoring, Gastroesophageal reflux, Gold colloid, Saliva


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