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Detection of gastric pepsin in middle ear fluid of children with chronic otitis media with effusion

Abstract

Objectives

To study the possible relationship between gastroesophageal reflux and chronic middle ear effusion by (i) evaluating the presence of pepsin/pepsinogen in middle ear fluid of children with chronic otitis media with effusion (OME) and to (ii) differentiate between pepsin from gastric juice and pepsin derived from plasma pepsinogen.

Patients and methods

This was a prospective study carried out in the Departments of Otorhinolaryngology and Clinical Pathology, Alexandria University. Middle ear effusions and blood samples were collected from 25 patients undergoing bilateral myringotomy with tube placement for chronic OME. These samples were prepared for pepsin assay. The total pepsin/pepsinogen concentrations of effusions and serum samples were measured with an enzyme-linked immunosorbent assay using human pepsin-specific antibody.

Results

Pepsin was detected in 22 of 25 (88%) patients and in 42 of 50 (84%) of the ears, and it was detected in all serum samples. A total of seven of 25 (28%) patients and nine of 50 (18%) ears were found to have higher pepsin levels in their middle ear effusion samples than the cut-off value of serum. The average pepsin level in all effusion samples was 109.99 ng/ml, whereas it was 55.72 ng/ml in serum samples.

Conclusion

The gastroesophageal reflux is one of the contributing factors in the etiopathogenesis of middle ear effusion as gastric pepsin reaches the middle ear through the nasopharynx and Eustachian tube to cause OME.

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Correspondence to Yasser Shewel MD.

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None declared.

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Shewel, Y., Bassiouny, M. & Rizk, M.M. Detection of gastric pepsin in middle ear fluid of children with chronic otitis media with effusion. Egypt J Otolaryngol 30, 78–81 (2014). https://doi.org/10.4103/1012-5574.133176

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Keywords

  • gastroesophageal reflux
  • otits media with effusion
  • pepsin