Pepsin and gastroesophageal reflux

2021/11/12

Pepsin has a solid digestive effect on the protein. Therefore, when it flows back into areas that lack barrier protection, such as the esophagus, it will adhere to the surface of epithelial cells and cause damage through proteolysis. When acid reflux occurs, the formation of a low pH environment can promote the deterioration of pepsin to the epithelium. And as time goes by, this kind of damage persists, occurs repeatedly, and further accumulates, leading to aggravation of reflux-related symptoms.

The detection of pepsin levels in saliva has been suggested as a non-invasive diagnostic method for reflux disease. A case-control study by HAYAT et al. showed that: (1) pepsin can be detected in the saliva of healthy subjects and heartburn patients, but healthy asymptomatic subjects have lower salivary pepsin levels; (2) reflux Related symptoms (gastroesophageal reflux disease and esophageal hypersensitivity) patients with saliva have a higher detection rate and level of pepsin than healthy controls; (3) A saliva sample that is positive for pepsin is helpful for the diagnosis of reflux-related symptoms The sensitivity is 78.6%, the specificity is 64.9%, and a positive sample with a high pepsin level (>210 ng/mL) has a specificity of 98.2% for gastroesophageal reflux disease and esophageal hypersensitivity, and has a very high specificity Positive predictive value (94.8%) and likelihood ratio (25.1).

BORTOL et al. sampled saliva in a small group of patients with typical symptoms of gastroesophageal reflux disease during the onset of symptoms. 94% of gastroesophageal reflux disease patients and 58% of esophageal hypersensitivity patients were positive for the pepsin in saliva, but functional Sexual heartburn patients are always negative. Compared with other diagnostic methods of gastroesophageal reflux disease, salivary pepsin detection has the advantages of being non-invasive and low cost. Some scholars have found that gastroesophageal reflux disease is potentially related to some lung diseases. It may cause respiratory symptoms and trigger or even aggravate respiratory conditions. These studies suggest that the detection of pepsin levels in exhaled condensed gas and saliva may be able to evaluate microaspiration caused by gastroesophageal reflux disease.

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