5 reasons why you should use a non-invasive test to identify reflux

But first, what is reflux?

Reflux is a common condition that occurs when the contents of the stomach pass through the lower oesophageal sphincter (LOS) and up into the oesophagus. This can cause symptoms such as heartburn, difficulty in swallowing, nausea and inflammation of the oesophagus. Under normal conditions, the oesophagus can withstand exposure to gastric content up to 5 % of the time without being adversely affected, but repeated episodes can cause gastro-oesophageal reflux disease (GORD), a condition that is thought to affect 20 to 40 % of the UK population.

And what is ‘silent’ reflux?

Laryngopharyngeal (LPR), or ‘silent’ reflux, is caused by gaseous bubbles containing an aerosol of the stomach contents – pepsin, bile salts, undigested food and possibly H. pylori – that travel up beyond the oesophagus to the delicate, easily damaged mucosal lining of the laryngeal and pharyngeal regions, causing symptoms such as a sore throat, a feeling of a lump in the throat and persistent throat clearing. These bubbles can even cause respiratory issues by passing down into the lungs or up into the nasal cavity, and so patients often put their symptoms down to coughs, colds or allergies. The oesophageal exposure to gastric content does not generally exceed 5 % in LPR, so patients don’t tend to suffer from heartburn.

Stomach, oesophagus and airways

The status quo on testing

A large majority of reflux patients are managed in primary care and are often prescribed with a proton pump inhibitor (PPI), such as omeprazole, to reduce the amount of stomach acid. The root cause of symptoms is not always fully investigated unless symptoms persist or are severe, or there has been no response to PPIs. However, a differential diagnosis is key to directing the right treatment or appropriate lifestyle changes. Current diagnostic pathways rely on time-consuming, inconvenient, invasive and costly techniques, including endoscopy, manometry, 24-hour pH monitoring, barium swallow and even biopsy.

 A better alternative for so many reasons

Peptest is a simple lateral flow test (similar to a pregnancy test) that measures pepsin in saliva samples. It is fast, cost-effective, more comfortable, safe and convenient for the patient, less open to operator variability, and less wasteful than traditional options.

1. Fast

Time-consuming techniques – like manometry and pH monitoring – take 24 hours or longer to perform, and there are frequent delays in reporting. In contrast, Peptest can confirm the presence or absence of pepsin in a patient’s sample within 20 minutes.

2. Cost-effective

Traditional diagnostic reflux tests frequently involve specialist personnel, facilities and materials, and an overall cost of around £750 to the NHS is not unusual. Peptest does not need specialised equipment, and costs around £25 per test for laboratories. 

3. More comfortable, safe and convenient for patients

Many of the current confirmatory tests for GORD and LPR are invasive, some are based on radiological techniques, and several require many patients to travel considerable distances for testing. Peptest uses a saliva sample, does not expose the patient to any radioactivity, and can be performed and analysed in a standard laboratory. Samples can either be handled by a GP’s surgery or patients can use a send-away service – in theory, they don’t even need to leave the house!

4. Less open to operator variability

There is a growing understanding that methods such as barium swallows and gastroscopy are subject to reliability issues due to a number of operator- and equipment-related factors. Peptest is based on robust lateral flow technology, making it far less susceptible to subjective interpretation. 

5. Less wasteful

It is estimated that up to 40 % of proton pump inhibitor (PPI) medication currently being prescribed by GPs to treat reflux could effectively be doing nothing! A differential diagnosis from Peptest at the primary care level could significantly cut this waste in prescription drugs.

 In summary…

Compared to the invasive, time-consuming, resource-heavy and costly traditional routes for testing, Peptest offers an accurate, painless and inexpensive option that clearly indicates the presence and level of pepsin to differentiate between GORD, LPR and other conditions that present as reflux. It has been shown to be an excellent biomarker for detecting airway reflux and LPR, with an overall sensitivity of 76.4 %. And because Peptest provides a quantitative measurement of pepsin in the sample, there is also potential for its use in monitoring treatment efficacy.