Reflux revisited: advancing the role of pepsin - PubMed (original) (raw)

Reflux revisited: advancing the role of pepsin

Karna Dev Bardhan et al. Int J Otolaryngol. 2012.

Abstract

Gastroesophageal reflux disease is mediated principally by acid. Today, we recognise reflux reaches beyond the esophagus, where pepsin, not acid, causes damage. Extraesophageal reflux occurs both as liquid and probably aerosol, the latter with a further reach. Pepsin is stable up to pH 7 and regains activity after reacidification. The enzyme adheres to laryngeal cells, depletes its defences, and causes further damage internally after its endocytosis. Extraesophageal reflux can today be detected by recognising pharyngeal acidification using a miniaturised pH probe and by the identification of pepsin in saliva and in exhaled breath condensate by a rapid, sensitive, and specific immunoassay. Proton pump inhibitors do not help the majority with extraesophageal reflux but specifically formulated alginates, which sieve pepsin, give benefit. These new insights may lead to the development of novel drugs that dramatically reduce pepsinogen secretion, block the effects of adherent pepsin, and give corresponding clinical benefit."For now we see through a glass, darkly."-First epistle, Chapter 13, Corinthians.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Example of pepsin profile from human gastric juice purified by HPAEC.

Similar articles

Cited by

References

    1. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4):1–78. - PubMed
    1. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. American Journal of Gastroenterology. 2006;101(8):1900–1920. - PubMed
    1. Johnson N, Toohill, RJ. Effects, Diagnosis and Management of Extra-Esophageal Reflux. New York, NY, USA: Nova Science Publishers; 2010.
    1. Dettmar PW, Castell DO, Heading RC. Reflux and its consequences. Alimentary Pharmacology & Therapeutics. 2011;33(supplement 1):1–71. - PubMed
    1. Savarino V, di Mario F, Scarpignato C. Proton pump inhibitors in GORD. An overview of their pharmacology, efficacy and safety. Pharmacological Research. 2009;59(3):135–153. - PubMed

LinkOut - more resources