Reflux revisited: advancing the role of pepsin.
Reflux revisited: advancing the role of pepsin.
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DOI：
10.1155/2012/646901
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发表时间：
2012
影响因子：
--
通讯作者：
Dettmar PW
中科院分区：
文献类型：
--
作者：
Bardhan KD;Strugala V;Dettmar PW
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
