Evidence map›Paper›PMID 42472916›Full record

ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

Salivary pepsin exposure in children with upper-airway symptoms: limited discrimination by RSI/RFS/RSS and diurnal patterns.

Chaofan Li, Chaohua Wang, Shaokun Huang, Ying Zhang, Fan Song, Chun Zhang, Xiaochun Li, Manman Cheng, Juan Ye, Guanghao Yue and 1 more

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Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Chaofan Li *Department of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Chaohua Wang *Department of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Shaokun HuangDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Ying ZhangDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Fan SongDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Chun ZhangDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Xiaochun LiDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Manman ChengDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Juan YeDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Guanghao YueDepartment of Otolaryngology, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, People's Republic of China.
Guoping YinBeijing Tsinghua Chang Gung Hospital, Tsinghua University, 168 Litang Road, Changping District, Beijing, 102218, People's Republic of China. yinguoping311@163.com.ORCID http://orcid.org/0000-0003-2576-4325

Funding

National Natural Science Foundation of China 82570130
6 · The paper itself

Abstract

objectivesTo assess the ability of the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and Reflux Symptom Score (RSS) to discriminate salivary pepsin exposure, and to explore relationships among latent clinical domains, adenoid obstruction, and diurnal pepsin burden in children.

methodsIn a prospective cross-sectional cohort of 84 children, RSI, RSS, and RFS were recorded. Standardized saliva samples (waking, post-lunch, post-dinner) were assayed for pepsin. ROC analyses evaluated clinical score discrimination across three positivity cutoffs [Formula: see text]. Exploratory factor analysis (EFA) reduced symptoms and signs into latent domains. Multidimensional k-means clustering defined diurnal rhythm phenotypes, and multivariable regression evaluated predictors of pepsin burden.

resultsSalivary pepsin was detected (> 16 ng/mL) in 71/84 children (84.5%). RSI, RFS, and RSS demonstrated near-chance discrimination across all cutoffs (AUC 0.46-0.60). Multidimensional clustering yielded diurnal profiles distinguished primarily by overall daily burden rather than isolated temporal peaks. Crucially, adenoid obstruction emerged as the predominant correlate for both continuous log-pepsin burden and high-load phenotype membership. In contrast, EFA-derived symptom domains and endoscopic signs (dominated by laryngeal edema) contributed limited independent predictive value.

conclusionsTraditional clinical scores exhibit poor construct validity and are insufficient as standalone proxies for pediatric LPR exposure. Rhythm-aware phenotyping demonstrates that cumulative diurnal pepsin burden is strongly associated with structural adenoid obstruction, suggesting a potential pathophysiological interplay and highlighting the necessity for objective, continuous exposure metrics in pediatric research. LEVEL OF EVIDENCE: 3:

Indexed as

Circadian RhythmGastroesophageal RefluxLaryngopharyngeal RefluxPepsin ASalivaAdenoidsChildChild, PreschoolCross-Sectional StudiesFemaleHumansMaleProspective StudiesROC CurveSeverity of Illness IndexPepsin AAdenoid hypertrophyDiurnal variationExploratory factor analysisPediatricPeptestPositivity cutoffsReflux exposureReflux finding scoreReflux symptom indexRhythm-based phenotypingROC analysisSalivary pepsinUpper-airway symptoms

Identifiers

PMID42472916

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.