The Function of Pepsin and pH Levels in the Nasal Secretions Due to Extraesophageal Reflux in Causing Chronic Rhinosinusitis

Background: The relationship between extraesophageal reflux and chronic rhinosinusitis remains a controversial feature in the literature. Recently some research has been done to prove this relationship and it found that there was relationship between gastroesophageal reflux disease with the occurrence of chronic rhinosinusitis. This research aimed to determine and analyze the presence and levels of pepsin and pH in nasal secretions due to extraesophageal reflux amongpatients with chronic rhinosinusitis concerning to complaints of laryngopharyngeal Reflux.

Method: The research was an analytical research with cross-sectional design. The research involved 27 patients with chronic rhinosinusitis, who were divided into two groups. Group 1 consisting of 8 patients with chronic rhinosinusitis accompanied with complaints of laryngopharyngeal reflux, and group 2 consisting of 19 patients with chronic rhinosinusitis without complaints of laryngopharyngeal reflux. The laryngopharyngeal reflux was determined from the questionnaires value of Reflux Symptom Index>13 and Reflux Finding Score determined by a flexible nasolaryngoendos copy examination with score >7. The level of pepsin and pH of both groups of patients were examined from the nasal secretion. The examination of pepsin using ELISA method and pH level measurement was using by pHmetri.

Result: Characteristic of respondence, 82.0% of respondence were their ages over 25 years old and 59.3% of them were females. 29.6% of chronic rhinosinusitis patients were accompanied by pharyngeal larynx reflux. Pepsin was found in all nasal secretions of chronic rhinosinusitis patients. Pepsin level of nasal secretions among Chronic Rhinosinusitis patients was 19.00 to 75.80 pg/ml with median 52.20 pg/ml. The pH level of nasal secretions among chronic rhinosinusitis patients were ranged from 6.00 to 6.80 with median of 6,39. Analysis by Mann-Whitney U-test revealed a significant change difference (p<0,05) between the two group. The level of pepsin was higher in the group chronic rhinosinusitis patients than complaints of laryngopharyngeal Reflux patients. The pH levels not statistically significant difference (p> 0.05) although it was found that the degree of acidity was higher (pH <6.5) in chronic rhinosinusitis patients than complaints of laryngopharyngeal reflux.

Conclusion: Extraesophageal reflux may be one of the factors that can cause chronic rhinosinusitis or aggravate chronic rhinosinusitis caused by infection or allergies. The presence of pepsin with high acidity (pH <6.5) can cause irritation of thelarynx mucosa, pharynx and sinonasal.So, the assessment of RSI, RFS, and pepsin and antirefluks therapy (PPI) is recommended to people with chronic rhinosinusitis who do not respond well or recurrent with standard chronic rhinosinusitis treatment.