Objective To determine whether
pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold
polyps and to evaluate the diagnostic value of
pepsin in vocal fold
polyps' tissues. Study Design Cross-sectional study. Setting Nanfang Hospital of Southern Medical University. Subjects and Methods The study included 32 patients with vocal fold
polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold
polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical
pepsin staining were performed. Results The expression of
pepsin was significantly higher in patients with vocal fold
polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The
pepsin levels were significantly positively correlated with upright position pharyngeal
acid reflux and
esophageal reflux parameters adjusted by age. Based on
pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%). Conclusion
Pepsin reflux may be a risk factor for vocal fold
polyps formation. In addition,
pepsin immunohistochemical analysis of
polyp biopsy samples appears to be a more sensitive and effective test for diagnosing
laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.