A pilot study demonstrating the evidence for reflux disease in patients presenting with non-allergic rhinitis (NAR)—reflux disease in association with non-allergic rhinitis

Qiuping Wang, Rhianna K. Lenham, Xiu Wang, Yifei Li, Manjie Jiang, Wei Chen, Li Xu, Changqing Yang, Andrew D. Woodcock, Peter W. Dettmar


Background: To overcome the misdiagnosis of reflux disease and provide subjects with the appropriate treatment determine the link between non-allergic rhinitis (NAR) and reflux disease through analyzing pepsin concentration in patients presenting with NAR using the reflux diagnostic test, Peptest.
Methods: Patients with negative allergen skin prick tests and CT scans of the sinuses were recruited from ENT outpatient visits. All patients provided an eosinophil count and underwent nasal endoscopy with all participants completing the Reflux Disease Questionnaire. Participants (31 patients and 42 healthy) provided one postprandial saliva sample and patients with NAR provided nasal lavage and additional saliva on waking and post-symptom for the determination of pepsin concentration by Peptest. Pepsin concentrations >25 ng/mL were considered positive and eosinophil counts <5% normal.
Results: A positive pepsin result was detected in all patients (100%), with the most frequent detection being in the postprandial sample (70.79%). A significant difference for pepsin concentration was determined in all NAR samples when compared to nasal lavage (P values; 0.0324, <0.001 and 0.0015). A lack of significant difference (P=0.9450) displayed the eosinophil count has no true effect associating NAR with reflux disease. A high sensitivity (87.1%), specificity (61.9%), positive predictive value (62.8%) and negative predictive value (86.7%) were determined using Peptest.
Conclusions: Patients with NAR displayed positive for reflux disease due to the significant concentration of pepsin present, specifically in the postprandial sample. The ease of Peptest provided quick and cost effective results and provided a clear link between NAR and reflux-disease.