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Usefulness of pepsin saliva measurement for the detection of primary burning mouth syndrome related to reflux

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objectives

To study the diagnostic value of salivary pepsin tests for detecting laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS).

Methods

Patients with BMS and asymptomatic individuals were consecutively recruited from September 2018 to June 2023. Patients underwent hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH) and saliva collections to measure pepsin. Stomatology evaluation was carried out to exclude other causes of BMS. Oral, pharyngeal and laryngeal signs and symptoms were evaluated with Reflux Sign Assessment (RSA) and Reflux Symptom Score (RSS). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin test were calculated considering the highest values of pepsin tests at ≥ 16, ≥ 36, and ≥ 100 ng/mL cutoffs. Receiver operating characteristic curve (ROC) was evaluated.

Results

Forty-nine patients with both BMS and LPR at the HEMII-pH and 21 asymptomatic individuals were recruited. Pepsin test was 83.7%, 79.6%, and 71.4% sensitive at cutoffs ≥ 16, ≥ 36, and ≥ 100 ng/mL, respectively. The ROC analysis reported that a threshold of ≥ 21.5 ng/mL was associated with sensitivity, specificity, PPV and NPV of 81.6%, 81.0%, 90.1% and 65.4%, respectively. The severity score of burning mouth symptom was significantly associated with the saliva pepsin concentration (rs = 0.263; p = 0.029) and the oral RSA (rs = 0.474; p = 0.007).

Conclusion

Pepsin test is a valuable diagnostic approach for detecting LPR in patients with BMS. Patients with high level of saliva pepsin reported more severe burning mouth symptoms. Future studies are needed to confirm the role of LPR in the primary BMS.

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Data availability

Data are available on request.

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Funding

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Authors and Affiliations

  1. Division of Laryngology and Bronchoesophagology, Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium

    Jérôme R. Lechien

  2. Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Foch Hospital, University Paris Saclay, Paris, France

    Jérôme R. Lechien

  3. Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium

    Jérôme R. Lechien

  4. Department of Otolaryngology, Elsan Hospital, Poitiers, France

    Jérôme R. Lechien & Francois Bobin

  5. Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy

    Luigi A. Vaira

  6. School of Biomedical Sciences, Biomedical Sciences Department, University of Sassari, Sassari, Italy

    Luigi A. Vaira

Authors
  1. Jérôme R. Lechien
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  2. Francois Bobin
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  3. Luigi A. Vaira
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Contributions

Study concept and design: JRL, LAV, FB. Acquisition, analysis, or interpretation of data: JRL, FB. Drafting of the manuscript: JRL. Critical revision of the manuscript for important intellectual content: LAV, FB.

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Correspondence to Jérôme R. Lechien.

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Patients consented to the study.

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Lechien, J.R., Bobin, F. & Vaira, L.A. Usefulness of pepsin saliva measurement for the detection of primary burning mouth syndrome related to reflux. Eur Arch Otorhinolaryngol 281, 827–833 (2024). https://doi.org/10.1007/s00405-023-08317-x

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  • DOI: https://doi.org/10.1007/s00405-023-08317-x

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