{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:05:21Z","timestamp":1787018721215,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Laryngopharyngeal reflux (LPR) is defined as the retropulsion of gastric contents into the larynx, oropharynx, and\/or nasopharynx. The 24\u2010hour combined hypopharyngeal\u2010esophageal multichannel intraluminal impedance with dual pH probe (24h\u2010HEMII\u2010pH) is currently the gold standard in LPR diagnosis; however, it is invasive, user dependent, and not always tolerated. This study assesses the diagnostic utility of salivary pepsin (Peptest) at different thresholds and during symptomatic periods as compared with the 24h\u2010HEMII\u2010pH probe in diagnosing LPR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Private laryngology clinic in Melbourne, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects and Methods<\/jats:title>\n                    <jats:p>Thirty\u2010five patients with a clinical history and endoscopic findings of LPR were recruited and simultaneously evaluated for LPR via 24h\u2010HEMII\u2010pH probe and salivary pepsin analysis at 5 key time points over the same 24\u2010hour period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Salivary pepsin was 76.9% sensitive and had a positive predictive value (PPV) of 87.0% at a threshold of 16\u00a0ng\/mL when compared with the 24h\u2010HEMII\u2010pH probe. If the pathologic pepsin threshold was raised to 75\u00a0ng\/mL, salivary pepsin had a sensitivity of 57.7%, a specificity of 75.0%, and a PPV of 93.8%. Symptomatic testing conferred a superior specificity at 16\u00a0ng\/mL (66.7%) and 75\u00a0ng\/mL (100.0%) and a superior PPV at 16\u00a0ng\/mL (92.3%) and 75\u00a0ng\/mL (100.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Salivary pepsin detection is a simpler, more cost\u2010effective, and less traumatic universal first\u2010line alternative to 24h\u2010HEMII\u2010pH probe in diagnosing LPR. Superior specificities conferring greater diagnostic value may be achieved with higher thresholds and symptomatic testing. If clinical suspicion remains high following negative salivary pepsin analysis, a 24h\u2010HEMII\u2010pH study could provide further diagnostic information.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599820951183","type":"journal-article","created":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T04:39:34Z","timestamp":1599539974000},"page":"375-380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Diagnostic Utility of Salivary Pepsin as Compared With 24\u2010Hour Dual pH\/Impedance Probe in Laryngopharyngeal Reflux"],"prefix":"10.1002","volume":"164","author":[{"given":"Michael","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Monash Health Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemente","family":"Chia","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Monash Health Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Stanley","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Monash Health Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra J.","family":"Phyland","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Monash Health Melbourne Australia"},{"name":"Department of Surgery Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia"},{"name":"Melbourne Swallow Analysis Centre Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Paddle","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Monash Health Melbourne Australia"},{"name":"Department of Surgery Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia"},{"name":"Melbourne Swallow Analysis Centre Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2006.01134.x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31802d83cf"},{"issue":"12","key":"e_1_2_8_4_1","first-page":"1534","article-title":"Evaluation and management of laryngopharyngeal reflux","volume":"294","author":"Ford CN","year":"2005","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(02)00097-8"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28506"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489400109S1003"},{"key":"e_1_2_8_8_1","first-page":"53","article-title":"Laryngopharyngeal reflux\u2014the ear, nose and throat patient","volume":"33","author":"Watson M","year":"2011","journal-title":"Ailment Pharm Ther"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm18001"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215111002234"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2018.07.008"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40136-016-0106-4"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816665819"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.10.041"},{"key":"e_1_2_8_15_1","unstructured":"Jamovi [computer program]. 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