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Correlation between laryngobronchoscopy and pepsin in the diagnosis of extra-oesophageal reflux

  • U Krishnan (a1) (a2), S Paul (a2), I Messina (a1) (a2) and M Soma (a3) (a2)



This study aimed to investigate pepsin as a marker of extra-oesophageal reflux disease by examining its presence in tracheal aspirates and correlating it with macroscopic changes on laryngobronchoscopy, along with the results of standard tests for gastro-oesophageal reflux disease and clinical features.


A retrospective review was undertaken of a cohort of 188 paediatric patients who underwent laryngobronchoscopy at a tertiary children's hospital and for whom pepsin assay results of tracheal aspirates were available. An association analysis was performed.


The mean patient age was 3.99 (3.40–4.58) years, with a male preponderance (55 per cent). Positive changes on laryngobronchoscopy were significantly associated with positive tracheal pepsin findings (p < 0.0001) but not with positive standard gastro-oesophageal reflux disease investigations. A positive pepsin assay was significantly associated with a history of recurrent croup (p = 0.0385) and a diagnosis of cystic fibrosis (p = 0.0232).


Macroscopic changes on laryngobronchoscopy were significantly associated with positive tracheal pepsin findings in this paediatric population, suggesting that extra-oesophageal reflux disease may be a contributing aetiology.


Corresponding author

Address for correspondence: Dr M Soma, Department of Paediatric Otolaryngology Head and Neck Surgery, Sydney Children's Hospital, High St, Randwick, NSW 2031, Australia Fax: +61(2)9382–1787 E-mail:


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Presented as a podium talk at the Annual Scientific Meeting of the Australian Society of Otolaryngology Head and Neck Surgeons, 30 March 2014, Brisbane, Australia



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