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Receptor Mediated Uptake of Pepsin: Significance in Otolaryngology

Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin
Milwaukee, WI

Reflux of gastric contents into the laryngopharynx contributes to voice disorders, otolaryngological inflammatory disorders, and perhaps even neoplastic diseases of the laryngopharynx. Treatment is currently focuses on increasing the pH of the refluxate because it was thought that the refluxate would not cause injury/symptoms at higher pH. However, many patients with reflux-attributed laryngeal injury/disease have persistent symptoms despite aggressive acid supression therapy. Recent studies using combined multi-channel intraluminal impedance with pH montioring have shown a positive symptom association with non- and weakly-acidic reflux and an association between non-/weakly acidic reflux and refractory symptoms on proton pump inhibitor therapy. Thus, the role of acid alone in the development of reflux related laryngeal pathology has to be questioned and studies examining the effects of the other components of the refluxate are clearly needed. Our data, described herein, supports a role for pepsin in reflux-attributed laryngeal injury/disease independent of the pH of the refluxate and highlights potential novel drug targets.