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I question the accuracy of "Peptest"

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Posted 3/4/2014 3:38 PM (GMT 0)
I know I've been posting a lot recently, but what with my symptoms changing so much, and worsening, I just had to grab the Peptest 3-sample kit once more, to figure out exactly how much I've been refluxing. I purposely chose 3 times when I had just belched up some liquid that both tasted foul, left a vomit-smell behind, made me short of breath/full of nausea and burned my throat. Sounds reasonable for testing for LPR reflux right? So, do you want to know how much pepsin was detected?

Zero.

Seriously. This time I felt the problem happening, and was kept up all night by it. It should have been the perfect sample for detecting reflux, but a zero? I thought of Bile reflux, but after some research, I found I'd still be bringing up at least a little bit of acid apparently, bile or none. So what's going on? Is Peptest simply not as accurate as we hoped? Or am I simply experiencing something that feels like reflux, but isn't?

(To add to my points, I can still taste something foul in my throat/nose, I'm still getting mucus/sinus problems, I still belch loads and I still have some nausea and trouble swallowing, even on meds/diet changes. Furthemore I have now obtained 18 Peptest samples this year, 17 of which are negative.)

Post Edited (Daxter) : 3/4/2014 9:10:10 AM (GMT-7)

Posted 3/4/2014 4:13 PM (GMT 0)
Hi Daxter,

Very strange indeed. The first 3 tests I did when my symptoms started with a burning throat mainly from gas - were also negative. Move on a year when I had the sour taste and upper dysphagia and my tests were off the charts.
I believe that a lot of consultants don't believe in the peptests - but I think they are pretty good. It may be that you are getting a lot of gas reflux rather than liquid and this may not show so well in the peptest results.
Have you had a high resolution ph that will show both PH and impedance in liquid and gas forms, that may be more beneficial?
Posted 3/4/2014 4:29 PM (GMT 0)

GC1pink said...
Hi Daxter,

Very strange indeed. The first 3 tests I did when my symptoms started with a burning throat mainly from gas - were also negative. Move on a year when I had the sour taste and upper dysphagia and my tests were off the charts.
I believe that a lot of consultants don't believe in the peptests - but I think they are pretty good. It may be that you are getting a lot of gas reflux rather than liquid and this may not show so well in the peptest results.
Have you had a high resolution ph that will show both PH and impedance in liquid and gas forms, that may be more beneficial?

A Restech probe is on the way in about a month's time. See, if pepsin really was the primary cause of LPR, surely enough of it would be refluxed in gaseous vapours for these tests to pick up, especially since there's enough to cause symptoms? Although like I said, I burped up full-fledged liquid, so that should've been valid too.

The one positive probe result I had was when I had virtually no symptoms whatsoever. I'm beginning to suspect that this was a normal reflux episode, caught by chance. Having said that, all my attempts to research another answer end in "LPR" so... I can only wish it's not.

EDIT: Er... I just discovered something ironic. On the sample in which pepsin was detected, I had eaten a cheese pizza. Such cheese is apparently prepared using... pepsin (among other enzymes). Well... no wonder I had pepsin detected at a time with no symptoms and while taking meds... XP

Post Edited (Daxter) : 3/4/2014 12:56:27 PM (GMT-7)

Posted 3/4/2014 5:46 PM (GMT 0)
Daxter,

If you are on PPIs or H2 blockers, or even regular use of antacids like Tums, Mylanta or even Gaviscon, then the Ph of your stomach may be too high to allow production of pepsin. The smell or taste of food triggers the release of HCL which will bring the Ph level to less than 4, which then allows the release of pepsin. If it never gets to less than 4 because of acid suppressing drugs, you'll get no pepsin, and a negative result on the test. At least that's the theory.

Which still leaves you with the ultimate question of what is causing the burning in your throat. I wouldn't dismiss the bile theory just yet. While you are right that there should be a little acid with the bile, if the acid suppressing drugs are working, there would be very little - not enough to reach a Ph level of 3 or less, and therefore - No Pepsin.
Posted 3/4/2014 7:29 PM (GMT 0)

rjdriver said...
Daxter,

If you are on PPIs or H2 blockers, or even regular use of antacids like Tums, Mylanta or even Gaviscon, then the Ph of your stomach may be too high to allow production of pepsin. The smell or taste of food triggers the release of HCL which will bring the Ph level to less than 4, which then allows the release of pepsin. If it never gets to less than 4 because of acid suppressing drugs, you'll get no pepsin, and a negative result on the test. At least that's the theory.

Which still leaves you with the ultimate question of what is causing the burning in your throat. I wouldn't dismiss the bile theory just yet. While you are right that there should be a little acid with the bile, if the acid suppressing drugs are working, there would be very little - not enough to reach a Ph level of 3 or less, and therefore - No Pepsin.

Good points; before I took the latest samples I ceased all medications for 96 hours - the minimum needed according to RDBiomed is 48 hours - so no H2 Blockers, no Gaviscon and no Mirtazapine, although the first and last ones were already stopped anyway. In that regard, I really hope the 24 hour probe can detect what is really happening. Bile reflux apparently does have a link to stress, so if it is the culprit behind my problems at least I have a chance of relieving it, if not curing it. It would also explain why the antidepressants work on my symptoms much better than any PPI/H2 Blocker/Antiacid ever has.

Oh also, I was on Cimetidine during my first 3 samples, and pepsin was still detected. Apparantly H2 Blockers don't affect the release of pepsin. I was also on Gaviscon Advance back then too; as far as I can tell, neither of them did anything to prevent a positive result. :p I found these too; do they sound like valid theories?

https://www.healingwell.com/community/default.aspx?f=45&m=2184357
http://www.healthboards.com/boards/acid-reflux-gerd/889036-lpr-nearly-cured-read.html

The 2nd one talks a lot about Vitamin D3, but I'd consider that theory a bit of a hoax. I've been on 1000 - 6000 IU for a whole year. My D3 levels were already high enough to "cure" LPR when I started out, and have only gotten higher since. It hasn't made a jot of difference for me. And if it is all about "acid vapours" how on earth do I stop them? I always have to burp, and if burping causes LPR then I'll never get rid of it ;(


EDIT: Just found that the pH needed to create pepsin initially can be up to ph 5, so there's a slightly larger margin there for its creation. Any higher, and I doubt ANYTHING would be digested at all, antiacids or not :)

Post Edited (Daxter) : 3/4/2014 1:28:22 PM (GMT-7)

Posted 3/4/2014 8:33 PM (GMT 0)
Daxter, I find your posts really interesting and I can relate to some of your symptoms.

I was sent for an abdominal scan by the GI consultant last September. I was told this was to check on my bile ducts .. anyway, they were ok and so they ruled out bile reflux. I was wondering if you have had this done?

Last November my symptoms were really bad and I ended up hardly sleeping or eating, anxious and depressed. I went on Mirtazapine just for five days and it stopped that vicious downward spiral. And yes it did have a positive effect on my LPR/reflux symptoms. I now take it in an unorthodox manner ... meaning that when my symptoms start to take a nosedive I'll take one Mirtazapine, go to bed early, get some solid sleep and this seems to "re-set" me for another couple of weeks. It has anti-emetic plus prokinectic elements.

Noelle
Posted 3/5/2014 11:16 AM (GMT 0)

Noelle3 said...
Daxter, I find your posts really interesting and I can relate to some of your symptoms.

I was sent for an abdominal scan by the GI consultant last September. I was told this was to check on my bile ducts .. anyway, they were ok and so they ruled out bile reflux. I was wondering if you have had this done?

Last November my symptoms were really bad and I ended up hardly sleeping or eating, anxious and depressed. I went on Mirtazapine just for five days and it stopped that vicious downward spiral. And yes it did have a positive effect on my LPR/reflux symptoms. I now take it in an unorthodox manner ... meaning that when my symptoms start to take a nosedive I'll take one Mirtazapine, go to bed early, get some solid sleep and this seems to "re-set" me for another couple of weeks. It has anti-emetic plus prokinectic elements.

Noelle

This is interesting; I knew Remeron/Mirtazapine had this properties, but the question we have to ask is why does it help when the more powerful PPIs/H2 Blockers don't, and when lifestyle/diet changes fail? I'd rather not be on drugs for life, not even an antidepressant, and Remeron doesn't completely stop my symptoms, but could it really all be down to stress? After all, everyone belches so surely these accursed "vapors" escape from everyone - maybe stressed people just notice it more?

Let me put it another way. Since receiving my latest results from RD Biomed, I have less "short of breath/nausea" feelings, and my throat isn't so tight. I'm only on 1/2 mg of Remeron every 2nd day. I still belch, get mucus and a burning throat, but how can such a small amount of antidepressant have such a profound effect on my LPR?Surely since I'm burping at the same, high rate, these "vapors" should still be escaping at the same rate, regardless of how acidic they are?

Honestly, LPR has me so bloody confused. Whatever I did to make it start, I wish I could go back and tell myself not to do it. ;(
Posted 3/5/2014 8:34 PM (GMT 0)
Daxter, as you will know there certainly is evidence if you research it that mirtazapine works for some with this condition when other "conventional" medications fail. I suppose it's like everything else, we are all different and what works well or well enough for some doesn't really help that much for others. So they discover that an AD helps with Gerd/Lpr ... this happens all the time. Many medications have off-label uses.

I understand what you mean about not wanting to be on a medication. I feel the same way, otherwise I would have stayed on Mirtazapine and not use it "as needed" like I do. The surgeon I saw mentioned Gabapentin and I feel the same way about that. And the thing with that is you can't start and stop it. Anyway I feel I've still got a lot more searching to do and I'm seeing another gastroenterologist in about six weeks time and possibly getting the ResTech done ... so I'm far off committing to a medication at this stage. But if nothing "concrete" presents itself, then I will most probably try Gabapentin, Amytriptyline or one of the nerve blocking medications because at that stage it will be a case of managing this illness as best I can because I don't wish to live a life in pain. But I'm not at the acceptance stage yet.

This is my take for what it's worth on this "all in the mind" business. Our brains have the ability to both intensify and decrease the amount of pain that we register. In addition each of us experiences pain in a different way.
One of the things that makes us upset and confused is when medics or even people we know hint that this may be all in our heads. Well sure it is!! .. since that is where we register and interpret the pain signals, but it is FUNDAMENTALLY stemming from a physical problem.

Take care and be kind to yourself. I won't suggest to not worry too much as I know it will sound trite to you. But do your best to not let it all get you down. You are not alone and others understand.

Take care.

Noelle
Posted 4/15/2014 12:51 PM (GMT 0)
Hi guys.

I work closely with RD Biomed and I just want to pick up on a few points raised here and put the record straight.

We have found that Peptest is a good indicator of reflux if pepsin is present in saliva samples. There is evidence to show that pepsin is still active at pH up to 6.5 and not deactivated until above pH 7 and that has driven all the discussions around using alkalised water to stop pepsin being aggressive and causing damage to the sensitive epithelial cell layers of the larynx and airways and causing LPR - although there is no clinical evidence for alkaline water.

If you're interested to read more I recommend that you read Bardhan et al - 'Reflux Revisited: Advancing the Role of Pepsin,' International Journal of Otolaryngology, vol. 2012, see - http://www.hindawi.com/journals/ijoto/2012/646901/

Pepsin will also still be present if taking PPIs or H2 receptor blockers as these drugs do not prevent reflux or the volume of reflux, they just alter the pH of the gastric juice but pepsin will still remain active and still be refluxed.

Stress can also in some individuals play a role in causing reflux and certainly lead to worst symptoms and often taking antidepressants can assist in relieving the symptoms of reflux and should be tried if everything else has failed to bring symptom relief.

Finally the Restech pH probe is certainly less invasive than 24-hour pH metry or impedance and useful in measuring the presence of acid reflux and can detect acid refluxed in an aerosol or mist form entering the airways, but it will not be able to detect the presence of pepsin and bile acids which are probable the main aggressive factors in LPR”.

Hope this helps.
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