- Pepsin is a stomach enzyme that serves to digest proteins found in ingested food.
- Gastric chief cells secrete pepsin as an inactive zymogen called pepsinogen.
- Parietal cells within the stomach lining secrete hydrochloric acid that lowers the pH of the stomach.
- A low pH (1.5 to 2) activates pepsin.
- Acetylcholine, gastrin, and histamine stimulate the proton pump in parietal cells to release hydrogen ions and decrease pH.
- A patient with weak upper and lower esophageal sphincters (UES and LES) can experience a retrograde flow of gastric juice, allowing pepsin to damage critical structures within the larynx.
- A weak UES and LES increase the risk of laryngopharyngeal reflux (LPR), a condition characterized by pepsin-mediated damage of structures within the larynx.
- Suspect LPR in a patient presenting with dysphagia, hoarseness, and chronic cough.
- Consider laryngoscopy for diagnostic confirmation.
- Manage patients with GERD and LPR by understanding what causes a weak UES and LES.
- Avoid caffeine, chocolate, fatty foods, alcohol to strengthen the LES and UES.
- Decreasing exertion during upright exercise can help strengthen the UES.