PEPSIN’S HIDDEN ROLE IN LPR
Pepsin is a digestive enzyme produced by the stomach to break down proteins. Under normal circumstances, pepsin remains confined to the stomach, where its acidic environment activates its enzymatic activity. However, in cases of LPR, pepsin can travel beyond its usual confines and wreak havoc on the delicate tissues of the upper respiratory tract.
One of the defining characteristics of pepsin is its remarkable stability in acidic and non-acidic environments, allowing it to retain its enzymatic activity even after reflux events. When pepsin comes into contact with the tissues of the throat and larynx, it can initiate a cascade of inflammatory responses, leading to symptoms such as hoarseness, chronic cough, throat clearing, and the sensation of a lump in the throat.
The insidious nature of pepsin lies in its ability to persist within the tissues long after the reflux event has ended. Studies have shown that pepsin can adhere to the surfaces of the upper airway for extended periods, perpetuating inflammation and tissue damage. This phenomenon may explain why some individuals with LPR continue to experience symptoms despite acid-suppressive therapy.
Emerging research suggests that certain dietary and lifestyle modifications may help mitigate the impact of pepsin in LPR. Avoiding acidic and spicy foods, maintaining a healthy weight, elevating the head of the bed during sleep, and refraining from eating close to bedtime are among the strategies recommended to reduce reflux episodes and minimize pepsin exposure to the upper airway.
While acid reflux undoubtedly plays a role in LPR, the presence of pepsin adds another layer of complexity to this multifaceted condition. We have gathered resources around the web that may be helpful in understanding pepsin and what could be done to alleviate the effects it may have on the upper airway:
How to Get Rid of Pepsin & Cure Your Acid Reflux, Dr. Jamie Koufman
Acid Reflux May Respond Better To Diet Than Drugs, Time Magazine
The importance of detecting pepsin to diagnose reflux, BIOHIT
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