Sage Journals: Discover world-class research

Abstract

Objective

To evaluate if analysis of pepsin/pepsinogen in middle ear effusions can be considered a diagnostic marker for laryngopharyngeal reflux (LPR) in children with otitis media with effusion (OME).

Material and Methods

Ambulatory 24-hour dualprobe pH monitoring was carried out on 31 children with OME. Middle ear effusions were collected from 17 children during myringotomy. Total pepsin/pepsinogen concentrations in effusions were measured by ELISA using antipepsin antibody.

Results

Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant LPR. The concentrations of pepsin/pepsinogen in middle ear effusions, ranged from 0.085 to 5.02 μg/ml, were found to be up to 4.5 to 231.44 times higher than the serum levels. There was a significant positive correlation between the level of pepsin/pepsinogen assayed in the effusions of the 17 children and the number of pharyngeal reflux episodes measured by pH monitoring.

Conclusions

Control of LPR may be an essential component in the successful management of OME in pediatric patients. Pepsin/pepsinogen analysis in effusions of children, using ELISA, can be considered a reliable marker for assessment of reflux in children with OME.

Get full access to this article

View all access options for this article.

References

Karkos

Assimakopoulos

Issing

WJ.

Pediatric middle ear infections and gastroesophageal reflux. Int J Pediatr Otorhinolaryngol 2004; 68:1489–92.

Heavner

Hardy

White

Transient inflammation and dysfunction of the Eustachian tube secondary to multiple exposures of simulated gastroesophageal refluxant. Ann Otol Rhinol Laryngol 2001; 110:928–34.

White

Heavner

Hardy

Gastroesophageal reflux and eustachian tube dysfunction in an animal model. Laryngoscope 2002; 112:955–61.

Tasker

Dettmar

Panetti

Is gastric reflux a cause of otitis media with effusion in children?

Laryngoscope 2002; 112:1930–4.

Lieu

Muthappan

Uppaluri

Association of reflux with otitis media in children. Otolaryngol Head Neck Surg 2005; 133:357–61.

Postma

GN.

Ambulatory pH monitoring methodology. Ann Otol Rhinol Laryngol 2000; 109:10–4.

Rudolph

Mazur

Liptak

Guide lines for evaluation and treatment of gastroesophageal reflux in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology and Nutrition.

J Pediatr Gastroenterol Nutr 2001; 32(Suppl): S1–31.

Postma

Belafsky

Aviv

Laryngopharyngeal reflux testing.

Ear Nose Throat J 2002; 81(Suppl):14–8.

Orenstein

Cohn

Shalaby

Reliability and validity of an infant gastroesophageal reflux questionnaire. Clin Pediatr (Phila) 1993; 32:472–84.

10.

Nelson

Chen

Syniar

Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 2000; 154:150–4.

11.

Vandenplas

Working Group of the European Society of Pediatric Gastroenterology and Nutrition. A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992; 14:467–71.

12.

Dubhan

Castell

DO.

Normal and abnormal proximal esophageal acid exposure: results of ambulatory dual-probe pH monitoring. Am J Gastroenterol 1993; 88:25–9.

13.

Panetti

Reville

Clyne

Clinical implications of the functional stability of pepsin. Presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery, September 1998, San Antonio, Texas.

14.

Koufman

JA.

Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease.

Ears Nose Throat J 2002; 81(Suppl):7–9.

15.

Rozmanica

Velepicb

Ahela

Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux in children with chronic tubotympanal disorders. J Pediatr Gastroenterol Nutr 2002; 34:278–80.

16.

Krishnan

Mitchell

Messina

Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr 2002; 35:303–8.

17.

Johnston

Knught

Dettmar

Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope 2004; 114:2129–34.

18.

Farrell

McMaster

Gibson

Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastrooesophageal reflux-related pulmonary aspiration. J Pediatr Surg 2006; 41:289–93.

19.

Yorulmaz

Ozlugedik

Kucuk

Gastroesophageal reflux disease: Symptoms versus pH monitoring results. Otolaryngol Head Neck Surg 2003; 129:582–6.

20.

Orlando

RC.

Mechanisms of reflux-induced epithelial injuries in the esophagus.

Am J Med 2000; 108(Suppl):1045–85.

21.

Marcinkiewicz

Han

Zbroch

The potential role of the esophageal pre-epithelial barrier components in the maintenance of integrity of the esophageal mucosa in patients with endoscopically negative gastroesophageal reflux disease. Am J Gastroenterol 2000; 95:1652–60.

Pepsin assay: A marker for reflux in pediatric glue ear