Hubungan Keberadaan Pepsin dalam Saliva terhadap Reflux Symptom Index dan Reflux Finding Score sebagai Metode Diagnostik pada Penderita dengan Gejala Refluks Laringofaring

Abstract

Introduction : Laryngopharyngeal reflux (LPR), which is caused by backflow of gastric contents into the upper aerodigestive tract, is often diagnosed as a cause of throat symptoms in Ear, Nose and Throat (ENT) patients. The diagnosis of LPR was made using Reflux Symptom Index (RSI), Reflux Finding Score (RFS) based on laryngoscopy findings, and percentage proximal acid exposure time with dual-probe pH monitoring. Ambulatory examination 24 hours doubleprobe pH metry is the gold standard for LPR diagnosis, but this examination is still far from ideal. The latest research to detect LPR is to determine the presence or absence of pepsin in the larynx using the immunoassay method; Enzyme-Linked Immunosorbent Assay (ELISA). Objective : To determine the relationship between the presence of pepsin in saliva and reflux symptom index and reflux finding score as a diagnostic method in patients with laryngopharyngeal reflux symptoms. Methods: This study is an analytical study using a cross-sectional approach conducted at the Otorhinolaryngology Head and Neck Surgery Department of the University of North Sumatra Hospital (USU) Medan by taking saliva from patients with LPR symptoms using the ELISA method Results: From 38 respondents, subjects aged > 45 years amounted to 19 people (50%), 13 people aged 26-45 years (34.2%) and 12-25 years old 6 people (15.8%) . Gender of women amounted to 22 people (57.9%) and men amounted to 16 people (42.1%). The mean RSI score was 18.13 (SD = 4.66) and the mean RFS score was 9.5 (SD = 1.94). The mean salivary pepsin level was 0.96 ng/mL (SD = 1.2 ng/mL). The cut-off value of salivary pepsin level for diagnosing LPR is 0.265 ng/mL. The sensitivity value of salivary pepsin levels in diagnosing LPR was 79.4%, the specificity value was 75%, the positive predictive value (PPV) was 96.4%, the negative predictive value (NPV) was 30% and the accuracy rate was 79%. Conclusion: Salivary pepsin level can be used to diagnose LPR with good level of ability (AUC > 80% - 90%).