Part #4 – Peptest
Professor Dettmar and his team developed a test for silent reflux that is available directly to patients, as well as health practitioners. It is called "Peptest".
The test in its current form is rather new to the market, so I had a few questions about it:
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How does Peptest work?
We use unique monoclonal human pepsin antibodies to detect the presence of pepsin in a patients saliva sample.
To analyze one sample takes us about 20 minutes. For the patients, it is completely non-invasive. All they have to do is to provide a salvia sample.
Pepsin should only be in the stomach. So if we are finding pepsin in the salvia, it means that you've had a reflux event.
Obviously, it also does depend on the concentration of pepsin found.
Many of us reflux low amounts every day, but not enough to cause significant damage. So what we're doing is looking at is the concentration of pepsin found by the Peptest.
The good thing about being able to measure the concentration of pepsin is that we can then repeat that test after treatment, advice & lifestyle changes. We can also do it pre- and post-surgery.
We are involved with LINX, and over here in the UK the LINX surgeons do use Peptest to indicate when a patient does have reflux. Then the patients are tested again maybe two months, six months, 12 months after they've had the surgery.
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On the website of Peptest you use the terms specificity and sensitivity to rate the effectiveness of Peptest in detecting reflux. Could you explain what those terms express exactly?
Tests like endoscopy, impedance, 24-hour pH tests and also Peptest are rated by how specific and sensitive they are.
The sensitivity is defined as to how sensitive is the test at being able to detect the presence of what you're looking for.
For example, an endoscopy is only 30 percent sensitive for detecting reflux. It's not really a reflux diagnostic test. If you had a 24-hour pH test for reflux disease, it's quite good at detecting acid reflux, probably about 50 to 60 percent sensitive. However, it is very poor at detecting weak acid reflux such as pepsin reflux.
If you're looking at something like Peptest, then depending on the concentration of pepsin found, it got a very high sensitivity. The sensitivity we quote for Peptest is 87-90 percent.
Specificity, on the other hand, means: how often is a test correct? In this case: how often are you correct in saying that someone has reflux or not? If you are right in half the cases, then the specificity is 50. A test that is always right would have a score of 100 – however that does not happen in medicine. For Peptest the specificity is about 90%.
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So when someone has reflux, could it be that the pepsin is just not reaching the mouth and the saliva, but you still have problems in your throat?
We use the Peptest in classical gastroesophageal reflux disease where you might consider the pepsin is only getting into the esophagus. What we've found is that we can still detect it in saliva, as it still gets up to there. So the test is used in gastroesophageal and laryngopharyngeal as well as airway and respiratory reflux disease.
There are other ways to collect samples as well.
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How many people are out there suffering from LPR without actually knowing it?
A lot of people. Especially older people. Their voice might get a bit gruffer, a bit rougher, and it might be due to reflux disease. But they just think: I'm getting older – it has nothing to do with reflux.
We did some studies in patients presenting at GP clinics here in the UK. We gave questionnaires out to see how many of those patients actually did have reflux-type symptoms.
We found it's about 26 percent of people who have reflux like symptoms – mostly without realizing it.
So if your question is: are there people walking around with reflux and not knowing about it? The answer is yes. Absolutely yes. It's really hard to put a figure on it, but you could probably say 10-20 percent of the population aren't aware that they have reflux disease.
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Peptest can help to make sure those patients with reflux symptoms really have LPR.
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This was the last part of the interview with Professor Peter Dettmar.
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