Objective:　To　investigate　the　diagnostic　value　of　the　fasting　hypopharyngeal　salivary　pepsin　concentration　test　for　laryngopharyngeal　reflux　disease　(LPRD).　Methods:　Volunteers　were　grouped　by　reflux　symptom　index　scale,　reflux　finding　score　scale,　and　24-h　hypopharyngeal-esophageal　multichannel　intraluminal　impedance　with　pH　monitoring　results.　The　study　comprised　56,　27,　and　20　individuals　in　the　LPRD,　asymptomatic　laryngopharyngeal　reflux (LPR),　and　asymptomatic　non-LPR　groups,　respectively.　All　underwent　a　fasting　hypopharyngeal　saliva　pepsin　testing　via　enzyme-linked　immunosorbent　assay.　Statistical　analysis　determined　the　optimal　diagnostic　cutoff　value,　sensitivity,　and　specificity　of　hypopharyngeal　salivary　pepsin　for　LPRD.　Correlation　analysis　was　performed　with　reflux　scale　scores　and　LPR　parameters.　Results:　Fasting　hypopharyngeal　salivary　pepsin　concentration　in　the　LPRD　group　was　significantly　higher　than　in　the　asymptomatic　control　group　(Z　=　−4.724,　p　＜　0.05).　The　area　under　the　receiver　operating　characteristic　curve　(AUC)　analysis　identified　an　optimal　cutoff　value　of　29.62　ng/mL　for　salivary　pepsin　concentration　(AUC,　0.767;　sensitivity,　51.8%;　and　specificity,　93.6%).　There　was　no　statistically　significant　difference　in　salivary　pepsin　concentration　between　the　asymptomatic　LPR　and　non-LPR　groups.　The　concentration　was　higher　in　the　LPRD　group　than　in　the　asymptomatic　LPR　and　non-LPR　groups　(p　＜　0.05).　Fasting　hypopharyngeal　salivary　pepsin　concentration　exhibited　a　weakly　positive　correlation　with　vocal　cord　edema,　intralaryngeal　mucus　adherence,　excess　throat　mucus　or　postnasal　drip,　coughing　during　meals/lying　down,　troublesome　or　annoying　cough,　and　liquid　and　weakly　acidic　reflux　episodes.　Conclusions:　The　fasting　hypopharyngeal　salivary　pepsin　concentration　test　is　a　highly　specific,　simple,　and　noninvasive　method　with　significant　clinical　diagnostic　value　for　LPRD.　©　2024　The　Author(s).　World　Journal　of　Otorhinolaryngology　-　Head　and　Neck　Surgery　published　by　John　Wiley　&　Sons　Ltd　on　behalf　of　Chinese　Medical　Association.