Diagnostic Value Of The Peptest^TM Combined With Oral Flora In Detecting Gastroesophageal Reflux Disease

Background Gastroesophageal reflux disease（GERD）is a common digestive system disease.GERD diagnosis methods include clinical history,questionnaire,diagnostic proton pump inhibitor（PPI）treatment,gastroscopy and reflux monitoring.However,these diagnosis methods are limited due to their lack of sensitivity or invasion.The purpose of this study was to explore the diagnostic value of pepsin concentration combined with oral flora in GERD as a non-invasive detection method.Methods This is a prospectively case–control study.A total of 72 patients and 20healthy subjects.6 patients withdrew from the study due to incomplete completion of examinations.Finally,66 patients completed the relevant examination and were included in the symptomatic patients（SP）,and 20 healthy subjects were included in the healthy control group（HC）.and SPs were divided into three groups based on the Lyon consensus:（1）conclusive GERD:presence of erosive esophagitis LA grades C or D,long segment Barrett’s esophagus or Peptic stricture and/or AET>6%;（2）inconclusive GERD:LA grade A or B,and/or AET between 4%and 6%,and/or 40 to 80 episodes of reflux;（3）evidence refute GERD:no erosive esophagitis,AET<4%,total reflux times<40.Meanwhile.All subjects were required to fill in the entire questionnaires,including reflux symptom index（RSI）,reflux disease questionnaire（RDQ）,oral hygiene index（OHI）,gastroscopyand complete saliva pepsin test.10 subjects in each group were selected to complete the oral flora measurement.In addition,all patients in SP group received high-resolution manometry（HRM）and 24h multichannel intraluminal impedance-p H（24h p H-MII）.Results Firstly,Pepsin concentrations were 123.20（44.10,148.05）ng/m L,27.65（0.00,90.80）ng/m L,8.00（0.00,36.80）ng/m L and 0（0.00,16.00）ng/m L in GERD group,inconclusive GERD group,evidence refute GERD group and HC group,The concentrations of pepsin between GERD group and the other three groups was significantly different（P<0.05）.Secondly,HC group showed higher bacterial abundance,as estimated by the ACE index and Chaol index,when compared with control group（P<0.05）.And the flora diversity index revealed no significant difference each group based on Shannon and Simpson indices（P>0.05）.LEf Se analysis showed that SP group had more Burkholderiales,Neisseriaceae,Neisseria and Neisseria perflava than HC group（P<0.001）.Finally,The sensitivity and specificity for diagnosing GERD were 83.3%and 75.0%,respectively,when the best cut-off value for pepsin concentration was 39.45 ng/m L,and the AUC was0.833±0.061（95%CI,0.714-0.952,P<0.001）.And when pepsin concentration was combined with oral flora,the sensitivity and specificity for diagnosing GERD were90.0%and 100.0%,respectively,AUC was 0.910±0.086（95%CI is 0.741–1.000,P=0.002）.Conclusion As a novel non-invasive method,Peptest ^TMcombined with oral microflora exhibited good diagnostic efficacy for GERD.The oral flora of GERD patients was different from that of the healthy population.Burkholderiales,Neisseriaceae may be helpful for the diagnosis of gastroesophageal reflux disease.