Factors affecting gastroesophageal reflux diagnosed by analysis of pepsin in the saliva of elderly patients with nasal feeding

Abstract Background Elderly patients receiving nasal feeding have weaker physiological function and placement of a nasogastric tube destroys the natural barrier of the cardia-esophageal sphincter. Pepsin in saliva may reflect gastroesophageal reflux disease (GERD). This study investigated pepsin levels in saliva of elderly patients with nasal feeding and analyzed the relevant factors. Methods This was a cross-sectional study. Patients admitted to the Chinese PLA General Hospital from April 2018 to October 2018 who received nasal feeding were included. One ml of saliva was collected from each patient during fasting in the morning and 1 hour after lunch for 3 consecutive days. Pepsin was quantified by enzyme-linked immunosorbent assay (ELISA). The patients were divided into two groups (≥7.75 ug/ml or <7.75 ug/ml) based on the median pepsin. Baseline and clinical factors were compared. ResultsThe mean age of the patients was 91.09±4.91 years. There were statistical differences in diabetes and feeding methods between the two groups. There was a positive correlation between the morning and postprandial pepsin levels (r=0.442, P <0.001). Multivariate analysis showed that the risk factors for higher pepsin levels were diabetes (odds ratio (OR): 2.67; 95%CI: 1.225-5.819, P =0.013) and nasal feeding methods (OR: 2.475; 95%CI: 1.183-5.180, P =0.016). Conclusions For patients undergoing nasal feeding who are older than 80 years, the fasting and 1-hour postprandial pepsin concentration was consistent. Diabetes and feeding methods are risk factors for high pepsin levels, which may indicate GERD.