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Pepsin as a biomarker for laryngopharyngeal reflux in children with laryngomalacia. Laryngoscope 2017 10;127(10):2413-2417



Pubmed ID




Scopus ID

2-s2.0-85013435856   8 Citations


OBJECTIVES/HYPOTHESIS: Laryngomalacia is a common cause of newborn stridor. Laryngopharyngeal reflux (LPR) has been associated with laryngomalacia. Although pepsin, a component of LPR, has been associated with inflammatory diseases of the aerodigestive tract, its presence in the airways of laryngomalacia patients is unknown.

STUDY DESIGN: Prospective case-control study comparing patients under age 3 years with laryngomalacia to children without laryngomalacia.

METHODS: Children less than 3 years old undergoing supraglottoplasty for laryngomalacia or surgery unrelated to the airway, without a history of laryngomalacia, reflux, or respiratory disease, were offered enrollment. Supraglottic lavage samples (3 mL) were obtained from all subjects. Two-millimeter arytenoid biopsies were collected from laryngomalacia patients. Pepsin Western blot and enzyme-linked immunosorbent assay were performed.

RESULTS: Ten laryngomalacia and five control subjects were enrolled. Pepsin was detected in lavages of laryngomalacia patients (8/10) but absent in controls (0/5; P = .007). Pepsin was observed more frequently in lavages (8/10) than biopsies (4/10; P = .046) of laryngomalacia subjects. Higher median pepsin concentration was observed in laryngomalacia than control lavages (P = .025).

CONCLUSIONS: Pepsin in supraglottic specimens demonstrated an association with laryngomalacia, supporting a role for refluxed pepsin in laryngomalacia. These data corroborate previous work implicating pepsin in inflammatory diseases of the upper airways. Further studies are warranted to investigate the contribution of pepsin to the pathophysiology of laryngomalacia.

LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:2413-2417, 2017.

Author List

Luebke K, Samuels TL, Chelius TH, Sulman CG, McCormick ME, Kerschner JE, Johnston N, Chun RH


Robert H. Chun MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Nikki Johnston PhD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Michael E. McCormick MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blotting, Western
Case-Control Studies
Electrophoresis, Polyacrylamide Gel
Enzyme-Linked Immunosorbent Assay
Laryngeal Mucosa
Laryngopharyngeal Reflux
Pepsin A
Prospective Studies
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280