Background Laryngopharyngeal reflux (LPR) is a prevalent disease in the ENT outpatient department. Methods of LPR diagnosis differ much. Narrow-band imaging (NBI) and Salivary pepsin-level measurements have been considered as totally new ways for the diagnosis of LPR in recent years. Aim We aimed to identify the specific manifestation of LPR and assess the correlation between NBI views and pepsin levels in LPR diagnosing. Materials and methods 130 Patients enrolled in our study were divided into LPR group and non-LPR group according to the scores of RSI and RFS. All individuals received endoscopic NBI tests and salivary pepsin measurements. NBI views of the larynx were divided into four grades based on the existing descriptive guidelines and our clinical observations, and the correlation between NBI grading and salivary pepsin levels was calculated. Results NBI grading and pepsin levels are significantly correlated with RFS/RSI scores. The diagnostic concentration of salivary pepsin was 33 ng/ml. There was a significant correlation between NBI grading and salivary levels. Conclusions and significance NBI grading system was proved to provide a better diagnostic value in the diagnosis of LPR. There was a possibility that a combination of these two methods might increase the diagnostic accuracy of this disease.