Clinical relevance of salivary pepsin detection in diagnosing gastroesophageal reflux disease subtypes.
Clinical relevance of salivary pepsin detection in diagnosing gastroesophageal reflux disease subtypes.
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DOI：
10.1093/gastro/goad053
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发表时间：
2023
影响因子：
3.6
通讯作者：
Xiao, Yinglian
中科院分区：
文献类型：
--
作者：
Zhang, Mengyu;Wu, Tingting;Tan, Niandi;Chen, Songfeng;Zhuang, Qianjun;Luo, Yu;Xiao, Yinglian
胃食管反流病（GERD）具有多种症状谱和反流特征。其明确诊断通常需要侵入性工具，包括内窥镜检查或反流监测。本研究的目的是探讨唾液胃蛋白酶检测作为一种非侵入性筛查工具诊断不同亚型胃食管反流的临床意义。共分析了77例疑似胃食管反流症状患者和12例无症状对照。所有参与者都进行了症状评估、上腔镜检查、食管测压和24小时多通道腔内阻抗-双pH探头监测。唾液在三个不同的时间点自行收集：空腹早期、餐后和症状出现时。通过Peptest检测唾液胃蛋白酶水平。根据受体-操作特征曲线确定唾液胃蛋白酶诊断远端或近端反流的最佳阈值。疑似胃食管反流患者唾液胃蛋白酶平均浓度显著高于对照组（100.63 [68.46,141.38]vs 67.90 [31.60, 115.06] ng/mL, P = 0.044），但不同症状谱患者间差异无统计学意义。远端反流组胃蛋白酶平均浓度高于非反流组（170.54 [106.31,262.76]vs 91.13 [63.35, 127.63] ng/mL, P = 0.043），而远端反流组与近端反流组之间无差异。唾液胃蛋白酶浓度诊断病理性远端反流的最佳临界值为157.10 ng/mL，高于病理性近端反流的最佳临界值122.65 ng/mL。唾液胃蛋白酶浓度与远端和近端反流参数显著相关。唾液胃蛋白酶测定可以帮助鉴别真正的胃食管反流与病理性远端反流或近端反流，无论不同的症状谱。诊断远端反流的阈值应高于诊断近端反流的阈值。
Gastroesophageal reflux disease (GERD) is heterogeneous with a varied symptom spectrum and reflux profiles. Its definite diagnosis often requires invasive tools including endoscopy or reflux monitoring. The aim of this study was to investigate the clinical relevance of salivary pepsin detection as a non-invasive screening tool to diagnose GERD of different subtypes. A total of 77 patients with suspected GERD symptoms and 12 asymptomatic controls were analysed. All participants performed symptom evaluation, upper endoscopy, esophageal manometry, and 24-hour multichannel intraluminal impedance-dual pH probe monitoring. Saliva was self-collected across three different time points: at early fasting, postprandially, and at symptom occurrence. Salivary pepsin levels were measured via Peptest. The optimal threshold of salivary pepsin for diagnosing distal or proximal reflux was determined according to a receiver-operating characteristic curve. The average salivary pepsin concentration of suspected GERD patients was significantly higher than that of controls (100.63 [68.46, 141.38] vs 67.90 [31.60, 115.06] ng/mL, P = 0.044), although no difference was found among patients with different symptom spectrums. The distal reflux group had a higher average pepsin concentration than non-reflux patients (170.54 [106.31, 262.76] vs 91.13 [63.35, 127.63] ng/mL, P = 0.043), while no difference was observed between the distal reflux group and the proximal reflux group. The optimal cut-off value of salivary pepsin concentration for diagnosing pathological distal reflux was 157.10 ng/mL, which was higher than that for diagnosing pathological proximal reflux (122.65 ng/mL). The salivary pepsin concentration was significantly correlated with distal and proximal reflux parameters. Salivary pepsin measurement can help in identifying true GERD with pathological distal reflux or proximal reflux, regardless of different symptom spectrums. A higher threshold should be applied for diagnosing distal reflux than for proximal reflux.
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影响因子：
29.4
作者：
Richter JE;Rubenstein JH
通讯作者：
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DOI：
10.1152/ajpgi.00175.2014
发表时间：
2015-03-15
期刊：
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