Diagnostic Accuracy and Optimal Thresholds of Salivary Pepsin (Peptest) in Laryngopharyngeal Reflux: A Systematic Review and Meta-Analysis.
Clin OtolaryngolAug 5, 2026 (epub)
Clinical ResearchOtolaryngology (ENT)
Do Hyun Kim, David W Jang, Se Hwan Hwang
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In 30 seconds
This systematic review and meta-analysis evaluated the diagnostic accuracy of salivary pepsin (Peptest) for laryngopharyngeal reflux (LPR) in 928 patients. The analysis found that a cut-off of 45-50 ng/mL yielded the highest diagnostic odds ratio of 6.08 and area under the curve of 0.772, indicating better performance compared to other thresholds. Multiple-time sampling significantly improved sensitivity.
Key findings
- Pooled diagnostic odds ratio (DOR) for Peptest at 45-50 ng/mL was 6.08.
- Area under the curve (AUC) for Peptest at 45-50 ng/mL was 0.772.
- Multiple-time sampling improved sensitivity to 0.82 compared to 0.33-0.63 for single-time sampling at 16 ng/mL.
- Peptest shows potential as a non-invasive alternative to 24-h-MII-pH monitoring.
Why it matters
Understanding the diagnostic accuracy of salivary pepsin can help clinicians identify LPR more effectively, potentially reducing the need for more invasive testing. Improved sensitivity with multiple samples may enhance diagnostic confidence.