- Design
- Systematic review and meta-analysis
- Population
- 28 studies, 2,070 children with chronic or recurrent otitis media
- Primary outcome
- Pepsin detection in middle ear effusion
- Effect
- Pooled detection 72.5% (95% CI 53.7–88.0%); higher than controls, Hedges' g 1.92 (0.58–3.25)
A meta-analysis pooled 28 studies of 2,070 children with chronic otitis media with effusion or recurrent otitis media. Pepsin or pepsinogen was found in 72.5% of middle ear effusions (95% CI 53.7–88.0%), and concentrations were much higher than in controls. Detection was 86% with ELISA but 18% with enzymatic assays.
Diagnostic criteria for reflux, laboratory methods and outcomes varied widely, so the pooled figure is a broad estimate. Finding pepsin in the ear shows that reflux material can reach it; it does not show that reflux causes the effusion or that treating reflux clears it.
In Indian practice, where proton pump inhibitors are widely prescribed for children with glue ear, this is a reason for caution rather than a new indication.
- Do not start acid suppression for glue ear on the basis of this association.
- Manage otitis media with effusion by watchful waiting, hearing assessment and grommets where indicated.
- Ask about reflux symptoms, but treat them on their own merits.
- Interpret pepsin results cautiously, since assay methods give very different detection rates.
Why it matters
It explains a biological link without justifying a common, unproven prescription.
Don't overread it
Pepsin in an effusion is an association; it does not show that reflux causes otitis media.
The statistics, in plain English
A Hedges' g of 1.92 is a very large difference in pepsin levels, but the interval (0.58–3.25) is wide and the studies were heterogeneous.
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