{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:54:57Z","timestamp":1790934897487,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Salivary pepsin has been proposed as a non\u2010invasive biomarker for diagnosing laryngopharyngeal reflux (LPR); however, its diagnostic utility remains uncertain due to inconsistent findings across studies. This meta\u2010analysis evaluated the diagnostic accuracy of a rapid lateral flow test (Peptest) compared to the reference standard of multichannel intraluminal impedance\u2010pH (MII\u2010pH) monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting<\/jats:title>\n                    <jats:p>Systematic review and meta\u2010analysis of cohort studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients with LPR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>The primary outcomes were diagnostic odds ratio (DOR), summary receiver operating characteristic curve and area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 11 studies comprising 928 samples were included. The diagnostic performance of salivary pepsin for LPR was analysed at cut\u2010off values of 16, 45\u201350 and 100\u2009ng\/mL. The pooled DOR and AUC were 3.49 and 0.684 at 16\u2009ng\/mL, 6.08 and 0.772 at 45\u201350\u2009ng\/mL and 4.78 and 0.717 at 100\u2009ng\/mL, respectively. Multiple\u2010time sampling significantly improved sensitivity compared to single\u2010time sampling across all cut\u2010off values (0.82 vs. 0.33\u20130.63 at 16\u2009ng\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), although specificity was slightly lower.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Peptest demonstrates potential as a simple, non\u2010invasive diagnostic alternative to 24\u2010h\u2010MII\u2010pH monitoring for LPR. Among the evaluated thresholds, a cut\u2010off of 45\u201350\u2009ng\/mL provided the highest diagnostic accuracy. Collecting multiple saliva samples may further enhance detection sensitivity. However, in patients with a high clinical suspicion of LPR but negative Peptest results, 24\u2010h\u2010MII\u2010pH monitoring remains necessary to confirm the diagnosis due to the test's limited negative predictive value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/coa.70154","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:20:47Z","timestamp":1785921647000},"page":"819-830","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy and Optimal Thresholds of Salivary Pepsin (Peptest) in Laryngopharyngeal Reflux: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9248-5572","authenticated-orcid":false,"given":"Do Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4200-7174","authenticated-orcid":false,"given":"David W.","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery &amp; Communication Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2838-7820","authenticated-orcid":false,"given":"Se Hwan","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.12.1534"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819827488"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31802d83cf"},{"key":"e_1_2_12_5_1","first-page":"7","article-title":"Laryngopharyngeal Reflux Is Different From Classic Gastroesophageal Reflux Disease","volume":"81","author":"Koufman J. 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