P188 A feasibility study of salivary pepsin measurement to assess airways reflux in exacerbating copd patients. (15th November 2017)

• Record Type: Journal Article
• Authors: Brown, TJB; Dettmar, P; Morice, AH; Hart, SP; Crooks, MG
• Is Part Of: Thorax. Volume 72(2017)Supplement 3
• Page Start: A184
• Page End: A185
• Publication Date: 2017-11-15
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210983.330
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Chronic Obstructive Pulmonary Disease (COPD) patients experience dyspnoea and cough and are prone to episodes of rapid worsening, termed acute exacerbations (AECOPD). Infections, air pollution and gastroesophageal reflux (GOR) have all been implicated in AECOPD. 1 Identification of GOR during AECOPD may allow targeted treatment. However, confirmation of GOR requires invasive procedures (e.g., pH manometry). Salivary pepsin measurement using Peptest (RDBiomed Ltd) offers a non-invasive alternative. We investigated the feasibility of using Peptest to detect salivary pepsin as a biomarker in AECOPD. Methods: 30 consecutive patients admitted within the last 24 hours with AECOPD were recruited and saliva collected daily for 7 days using a standard method. Pepsin was measured using Peptest. GOR was considered present if pepsin was ≥75 ng/ml. Participants completed the following questionnaires on day 1: Frequency Scale for Symptoms of GORD, Hull Airways Reflux Questionnaire and COPD assessment test. Additional demographic and clinical data were collected. Data are presented as mean ±SD. Results: Thirty patients (Males: 18, Age: 64.1±12.6, current smokers: 18) were recruited over 30 days. 81% of eligible patients consented. 70% completed the study. Salivary pepsin levels over 7 days are presented in figure 1 . 24/30 participants (80%) had salivary pepsin ≥75 ng/ml on day 1. Mean pepsin levels reduced significantly during the 7 days with highest levels observed on day 1 (p<0.01). There was no correlation between day 1 salivary pepsin and symptom questionnaires. Salivary pepsin measurement over 7 days identified four patterns: persistently low (n=3); persistently high (n=3); high on day 1 only (n=6); and variable (n=13). Discussion: Peptest was acceptable to patients. Salivary pepsin measurement appears to be able to categorise different population groups by pattern of pepsin concentration throughout the week. As a feasibility study, it was not powered to identify correlation with clinical outcomes. Our Results suggest that using salivary pepsin as a marker of GOR is feasible and is worthy of further study in a large prospective cohort to evaluate its relationship to outcomes. Reference: Rascon-Aguilar IE, Pamer M, Wludyka P, Cury J. Role of gastroesophageal reflux symptoms in exacerbations of COPD. Chest2006;130(4):1096.