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Gastric Acid and Pepsin Roles in Reflux Disease

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Laryngopharyngeal and Gastroesophageal Reflux

Abstract

Gastric acid plays a very important role in the digestion of food including the denaturation of proteins in the stomach. It is released from parietal cells through the actions of the vagus nerve and hormones such as gastrin and histamine. The presence of gastric acid in the stomach lumen allows the activation of pepsinogen to pepsin, which is important for protein digestion. Gastric acid also plays a disinfectant role in the stomach; however, excess acid secretion may reflux in the esophagus and laryngopharynx and cause mucosal injury and reflux disease. Recent studies have also described a role for pepsin in reflux disease independent of gastric acid. MII-pH and salivary pepsin data appear to correlate well, suggesting pepsin in saliva may be a noninvasive diagnostic biomarker for proximal airway reflux. Currently, a myriad of pharmacological medications are used for reflux disease management; and recent studies have demonstrated symptomatic benefits with the use of Mediterranean diet. Recent studies have also explored targeting pepsin to treat reflux disease refractory to acid suppression medication. Two mechanisms by which pepsin might be targeted have been identified: irreversible inactivation and via receptor antagonism.

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Authors and Affiliations

  1. Medical College of Wisconsin, Milwaukee, WI, USA

    Claude Nganzeu

  2. Department of Otolaryngology & Communication Sciences, Division of Laryngology & Professional Voice, Medical College of Wisconsin, Milwaukee, WI, USA

    Jonathan M. Bock

  3. Department of Otolaryngology and Communication Sciences, Division of Laryngology and Professional Voice and Pediatric Otolaryngology, Department of Microbiology and Immunology, Milwaukee, WI, USA

    Nikki Johnston

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  1. Claude Nganzeu
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Correspondence to Nikki Johnston .

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  1. ENT and Allergy Associates, LLP; Voice and Swallow Division, Tarrytown, NY, USA

    Craig H. Zalvan

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Nganzeu, C., Bock, J.M., Johnston, N. (2020). Gastric Acid and Pepsin Roles in Reflux Disease. In: Zalvan, C.H. (eds) Laryngopharyngeal and Gastroesophageal Reflux. Springer, Cham. https://doi.org/10.1007/978-3-030-48890-1_4

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  • DOI: https://doi.org/10.1007/978-3-030-48890-1_4

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