{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T18:08:23Z","timestamp":1778177303721,"version":"3.51.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"ACG Junior Faculty Development"},{"name":"University of Colorado Department of Medicine Outstanding Early Scholars Program"},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Uncertain diagnostic performance has limited clinical adoption of salivary pepsin, a noninvasive diagnostic tool for gastroesophageal reflux disease (GERD). This study aimed to assess diagnostic performance of salivary pepsin, and test validity of thresholds in an external cohort of patients with or without GERD. This two-phase prospective study conducted at two centers enrolled adult asymptomatic volunteers, patients with symptoms of GERD undergoing reflux monitoring, and patients with Barrett\u2019s esophagus (BE). Fasting saliva samples were processed for pepsin concentration using Peptest. Phase 1 compared pepsin concentration between No GERD (volunteers\/functional heartburn) and GERD (erosive reflux disease\/nonerosive reflux disease (NERD)\/BE). Phase 2 tested validity of the diagnostic thresholds identified from Phase 1 among external functional heartburn and NERD cohorts. Of 243 enrolled subjects, 156 met inclusion criteria. Phase 1 (n\u2009=\u2009114): Pepsin concentrations were significantly higher in GERD (n\u2009=\u200984) versus No GERD (n\u2009=\u200930) (73.8\u00a0ng\/mL vs. 21.1\u00a0ng\/mL; P\u2009&amp;lt;\u20090.001). Area under the curve for pepsin concentration was 0.74 (95% CI 0.65, 0.83). A salivary pepsin threshold of 24.9\u00a0ng\/mL optimized the true negative rate and 100.0\u00a0ng\/mL optimized the true positive rate. Phase 2 (n\u2009=\u200942): Pepsin concentrations were significantly higher in NERD (n\u2009=\u200922) versus Functional Heartburn (n\u2009=\u200920) (176.0\u00a0ng\/mL vs. 53.3\u00a0ng\/mL, P\u2009&amp;lt;\u20090.001). Applying Phase 1 thresholds in this external cohort, salivary pepsin 24.9\u00a0ng\/mL was 86% sensitive (64%, 97%) and 100.0\u00a0ng\/mL was 72% specific for distinguishing NERD from functional heartburn. Given modest sensitivity and specificity for GERD, salivary pepsin may have clinical utility as a noninvasive office based diagnostic screening tool for GERD.<\/jats:p>","DOI":"10.1093\/dote\/doaa117","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T17:58:03Z","timestamp":1605203883000},"source":"Crossref","is-referenced-by-count":23,"title":["Diagnostic performance of salivary pepsin for gastroesophageal reflux disease"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7872-2033","authenticated-orcid":false,"given":"Rena","family":"Yadlapati","sequence":"first","affiliation":[{"name":"Division of Gastroenterology , , San Diego School of Medicine, La Jolla, CA, USA"},{"name":"University of California , , San Diego School of Medicine, La Jolla, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Kaizer","sequence":"additional","affiliation":[{"name":"University of Colorado , Anschutz Medical Campus, Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline","family":"Greytak","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology , , San Diego School of Medicine, La Jolla, CA, USA"},{"name":"University of California , , San Diego School of Medicine, La Jolla, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eze","family":"Ezekewe","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology , , Aurora, CO, USA"},{"name":"University of Colorado Anschutz Medical Campus , , Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Violette","family":"Simon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology , , Aurora, CO, USA"},{"name":"University of Colorado Anschutz Medical Campus , , Aurora, CO, 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