{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:30:22Z","timestamp":1785767422578,"version":"3.56.0"},"reference-count":18,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>We aimed to evaluate the application of Peptest, a novel technique to detect pepsin in the saliva, and identify its threshold level for the diagnosis of gastroesophageal reflux disease (GERD) with extraesophageal symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional study was conducted in two groups: patients with extraesophageal GERD symptoms (symptomatic group divided into GERD and non\u2010GERD groups according to 24\u2010h esophageal pH\u2010impedance monitoring [pH\u2010I] results) and healthy controls. For the symptomatic group, endoscopy, pH 24\u2009h, high\u2010resolution manometry (HRM), and salivary Peptest were performed. For the healthy control group, only Peptest was done. The accuracy of Peptest was compared with that of pH\u2010I by the Lyon consensus criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Chronic laryngitis was the most frequent extraesophageal symptom. On saliva testing, the GERD group had a higher prevalence of positive samples and pepsin concentration than the control group. Between GERD and non\u2010GERD groups, the optimal threshold level was 31.2\u2009ng\/mL, with a sensitivity of 86.7% and specificity of 27.5%. The optimal threshold level was 31.4\u2009ng\/mL to differentiate GERD from healthy controls, with a sensitivity of 86.7% and specificity of 66.0%. Age, number of total refluxes, DeMeester score, post\u2010reflux swallow\u2010induced peristaltic wave (PSPW) index, and mean nocturnal baseline impedence (MNBI) were associated with pepsin concentration. Regarding HRM metrics, there was no significant difference of pepsin concentration between low\/normal upper esophageal sphincter (UES) resting pressure, low\/normal lower esophageal sphincter (LES) resting pressure, low\/normal 4\u2010s integrated relaxation pressure (IRP4s), and hypomotility\/normal motility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with extraesophageal symptoms had a higher prevalence of positive Peptest. The optimum threshold level of 31.4\u2009ng\/mL had high sensitivity and moderate specificity to differentiate between patients with GERD and healthy controls.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.13002","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T21:53:52Z","timestamp":1700603632000},"page":"916-922","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Threshold level of Peptest in diagnosing gastroesophageal reflux disease with extraesophageal symptoms: Evidence from Vietnam"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6503-781X","authenticated-orcid":false,"given":"Linh T","family":"Nguyen","sequence":"first","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"},{"name":"Hanoi\u2009Medical\u2009University  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tung D","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Physiology Hanoi Medical University  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2829-3875","authenticated-orcid":false,"given":"Long B","family":"Hoang","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vung T","family":"Vu","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thang D","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hue T M","family":"Luu","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phuong N","family":"Do","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"},{"name":"Hoang Long Clinic  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh","family":"Van Nguyen","sequence":"additional","affiliation":[{"name":"Hoang Long Clinic  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Van Dao","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology  Hanoi Vietnam"},{"name":"Hoang Long Clinic  Hanoi Vietnam"},{"name":"Internal Medicine Faculty Hanoi Medical University  Hanoi Vietnam"},{"name":"Endoscopy Centre Hanoi Medical University Hospital  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattias","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Global Public Health 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