Weitzendorfer M, Antoniou SA, Schredl P, et al. - For the diagnosis of laryngopharyngeal reflux (LPR), researchers contrasted the diagnostic accuracy of salivary pepsin with oropharyngeal pH monitoring using the Restech measurement system (Dx-pH). Between October 2015 and May 2018, 70 patients with primary LPR-related symptoms had gastroscopy, high-resolution manometry, pH throughout 24-hour monitoring (MII-pH), and barium esophagography. Additionally, an examination of the ear, nose, and throat, including Belafsky Reflux Finding Score (RFS) analysis, was conducted. Data reported that 41 individuals with a pathological DeMeester score exhibited higher mean values of pepsin vs patients with a normal DeMeester score. Salivary pepsin demonstrated an 86.2% specificity and a 41.5% sensitivity to diagnose LPR using the optimum cutoff value of 216 ng/mL. In addition, in patients with pathological findings in MII-pH, a strong association between salivary pepsin values and Belafsky Reflux Symptom Index (RSI) score was found. Nevertheless, there was no significant correlation between elevated Dx-pH measurements and either MII-pH, RSI score, RFS score, or Gastrointestinal Quality of Life Index score, or pepsin measurement tests. The results obtained from the prospective cohort study suggest that pepsin measurement in saliva could be an effective method to assist with office-based LPR diagnosis, although Dx-pH does not appear to be an appropriate examination. Nevertheless, to arrive at more definite conclusions, larger controlled trials are needed.