{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:01:41Z","timestamp":1791842501469,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006282","name":"Koning Boudewijnstichting","doi-asserted-by":"publisher","award":["2020"],"award-info":[{"award-number":["2020"]}],"id":[{"id":"10.13039\/501100006282","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic performance of multiple digestive enzyme biomarkers in detecting and characterizing laryngopharyngeal reflux disease (LPRD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with LPRD at the 24\u2010h hypopharyngeal\u2010esophageal multichannel intraluminal impedance\u2010pH testing (HEMII\u2010pH) were consecutively recruited from January 2020 to May 2024 from two European hospitals. The control group consisted of adults without symptoms. Prospective clinical data collection included demographics, gastrointestinal endoscopy, HEMII\u2010pH, reflux symptom score (RSS), and reflux sign assessment (RSA) findings. At baseline, pepsin, elastase, cholesterol, bile acids, trypsin, pancreatic, and gastric lipase were measured in saliva samples of LPRD patients and asymptomatic individuals. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy (receiver operating characteristic (ROC) curve and area under the curve (AUC)) were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred and twenty\u2010three patients and forty\u2010eight asymptomatic individuals were prospectively recruited. Patients exhibited significantly elevated salivary pH and elastase levels, but decreased cholesterol compared to controls. Salivary cholesterol demonstrated superior diagnostic performance (AUC\u2009=\u20090.989), with a 2.05\u2009mg\/dL threshold yielding excellent sensitivity (100%), specificity (94.3%), and predictive values. Elastase showed moderate\u2010to\u2010high diagnostic performance (AUC\u2009=\u20090.811, threshold &gt;\u200949.2\u2009\u03bcg\/mL). Combined RSS\u2009&gt;\u200913 and salivary pH demonstrated robust diagnostic accuracy (SE\u2009=\u200988.8%, SP\u2009=\u200997.1%). Cholesterol positively correlated with 3\u2010month RSS (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.538).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Salivary cholesterol, elastase, and the salivary pH emerge as promising diagnostic biomarkers for LPRD, demonstrating superior accuracy to other digestive enzymes and potential value in predicting treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  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Otolaryngology, Elsan Polyclinic de L'atlantique  Poitiers France"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, CHU Saint\u2010Pierre  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"El Ayoubi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, CHU Saint\u2010Pierre  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinciane","family":"Muls","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, CHU Saint\u2010Pierre  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Hans","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Foch Hospital, School of Medicine, Paris Saclay University, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Universit\u00e9 Sorbonne Nouvelle\/Paris 3)  Paris 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