The characteristics of salivary pepsin in patients with severe motor and intellectual disabilities

Clinical utility of salivary pepsin measurement in patients with proton pump inhibitor-refractory gastroesophageal reflux disease symptoms: a prospective comparative study

BACKGROUND

Salivary pepsin measurement has been reported to be useful for diagnosing gastroesophageal reflux disease (GERD). This study aimed to clarify the usefulness of salivary pepsin measurement in patients with proton pump inhibitor (PPI)-refractory GERD symptoms without erosive esophagitis.

METHODS

One hundred and two patients were included. Over seven days after terminating PPI treatment, all patients underwent a 24-h pH-impedance test and salivary pepsin measurement. In patients whose main symptoms included laryngopharyngeal symptoms, a hypopharyngeal multichannel intraluminal impedance (HMII) test was performed, whereas in other patients, a conventional combined multichannel intraluminal impedance-pH (MII-pH) test was performed. In the HMII tests, patients were divided into abnormal proximal exposure (APE) and non-APE groups. Salivary pepsin concentrations were compared according to acid exposure time (AET) values and were also compared between the APE and non-APE groups.

RESULTS

The median salivary pepsin concentration in patients with AET > 6% was significantly higher than that in patients with AET ≤ 6% (345.0 [170.0-469.3] ng/mL vs. 120.0 [97.0-290.1] ng/mL, p < 0.01). The sensitivity, specificity, positive predictive value, and negative predictive value of a positive test (> 109 ng/mL) to diagnose patients with AET > 6% were 75.0%, 51.3%, 32.1%, and 86.9%, respectively. There was no significant difference between concentrations in the APE group and concentrations in the non-APE group.

CONCLUSIONS

In patients with PPI-refractory nonerosive reflux disease, salivary pepsin measurement may help diagnose patients who have conclusive evidence of reflux, whereas it is not adequate for identifying patients with APE.

Salivary Theranostics in Pediatric and Special Care Dentistry

Saliva as a microfluidic system offers numerous advantages for both general and oral health diagnostic and therapeutic procedures since its assembly is quick, stress-free, inexpensive and non-invasive. Moreover, saliva is frequently referred to as a mirror of the body due to the fact that it can reflect the physiological and pathological state of the body. More than a decade ago the term “Salivaomics” has been introduced with the aim of emphasizing the development of research, knowledge and applications of five salivary constituents: proteome, transcriptome, micro-RNA, metabolome, and microbiome. Contemporary oral health care delivery in pediatric and special care dentistry is focused toward the development of new diagnostic and therapeutical procedures that are essentially noninvasive due to common issue of intolerability to invasive procedures among these patients, with the possibility of increasing participation rates. Besides the criteria of being easily and non-invasive collected, there are additional standards that should be met before routine application in everyday clinical practice; the existence of specific biomarkers for a disease, and ability of having its biomarkers detected using present-day equipment. For example, there are recent suggestions that a salivary RNA panel could objectively differentiate children with autism spectrum disorder from their neurotypical peers. In addition, due to the ease of the administration, the oral cavity is an attractive site for the drug delivery systems development because through this route it is possible to realize mucosal and transmucosal, systemic effect. All these contemporary advances extended the salivary diagnostic approach from the oral to general health pointing towards a promising future of salivary diagnostics for personalized medicine devices.

Pepsin in Saliva as a Diagnostic Marker for Gastroesophageal Reflux Disease: A Meta-Analysis

BACKGROUND Gastroesophageal reflux disease (GERD) is very common. Salivary pepsin detection has previously been considered as a method for GERD diagnosis. We performed a meta-analysis to investigate the utility of salivary pepsin assay as a diagnostic tool of GERD. MATERIAL AND METHODS PubMed, Web of Science, the Cochran Library, and EMBASE (from January 1980 to 23 October 2018) were searched for pepsin in saliva for GERD diagnosis. We summarized the retrieved specificity, sensitivity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves data in the meta-analysis. RESULTS In final analysis, a total of 5 studies were included. The summary sensitivity, specificity, NLR, and PLR were 0.60 (95% CI 0.41-0.76), 0.71 (95% CI 0.51-0.86), 0.56 (95% CI 0.34-0.93), and 2.1 (95% CI 1.1-4.1), respectively. The pooled DOR was 4 (95% CI 1.0-11.0) and area under the ROC was 0.70 (95% CI 0.66-0.74). CONCLUSIONS The meta-analysis showed that pepsin in saliva has moderate diagnostic value for GERD, and is not as helpful as previously thought.