Can pepsin immunohistochemical staining of laryngeal lesions accurately diagnose non-acid laryngeal reflux?

AbstractBackground Non-acid reflux is the most common form of laryngopharyngeal reflux (LPR). However, the damage caused by non-acid reflux to the laryngeal mucosa is weaker than that caused by acid reflux.Aims To evaluate whether pepsin immunohistochemical (IHC) staining of laryngeal lesions can accurately diagnose acidic and non-acidic LPR.Materials and Methods Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring was performed, and the patients were divided into acid reflux and non-acid reflux groups. Pathological sections of laryngeal lesions were examined using pepsin IHC staining, which was positive when pepsin was detected in the cytoplasm.Results The study included 136 patients, with 58 in the acid reflux group, 43 in the non-acid reflux group, and 35 in the without reflux group. There were no significant differences in the positive rate of pepsin IHC staining between the non-acid and acid reflux groups (p = .421). The sensitivity of pepsin IHC staining for the diagnosis of acid and non-acid reflux was 94.8% and 90.7%, respectively.Conclusions The sensitivity of pepsin IHC staining for laryngeal lesions in the diagnosis of non-acidic LPR is satisfactory.Significance Pepsin IHC staining is suitable for LPR screening of patients with laryngeal lesions as it is economical, non-invasive, and highly sensitive.Chinese Abstract背景：非酸反流是最常见的喉咽反流 (LPR) 形式。 但是, 非胃酸反流对喉黏膜的损害比胃酸反流造成的损害要弱。目的：评估喉部病变的胃蛋白酶免疫组织化学（IHC）染色能否准确诊断酸性和非酸性 喉咽反流。材料和方法：进行了下咽-食管多通道腔内阻抗-pH监测, 将患者分为胃酸反流组和非胃酸反流组。通过胃蛋白酶IHC染色检查喉部病变病理切片；在细胞质中检测到胃蛋白酶时, 胃蛋白酶IHC染色呈阳性。结果：该研究包括 136 名患者, 其中酸反流组 58 名, 非酸反流组 43 名, 无反流组 35 名。非酸和酸反流组之间的胃蛋白酶 IHC 染色阳性率无显著差异(p=.421)。 用于诊断酸和非酸反流的胃蛋白酶 IHC染色 的敏感性分别为 94.8% 和 90.7%。结论：喉部病变胃蛋白酶 IHC 染色对诊断非酸性LPR的敏感性令人满意。意义：胃蛋白酶 IHC 染色适用于喉部病变患者的 LPR 筛查, 因为它经济、无创且高度敏感。Keywords: Laryngopharyngeal refluxnon-acid refluxpepsinpH monitoring Ethical approvalAll procedures performed in this study involving human participants followed the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments.Informed consentInformed consent was obtained from all individual participants included in the study.Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThis work was supported by the Capital’s Funds for Health Improvement and Research [2016-2-5111].