Pepsin, Mucosal Injury, and Pathophysiology of Non-acid Reflux.

The gastric enzyme pepsin is a critically under-addressed aggressor during reflux disease and is regarded by many as the most damaging element of laryngopharyngeal reflux. Research over the last 2 decades has elucidated mechanisms by which pepsin causes damage during weakly and nonacid reflux yielding information to exploit its diagnostic and therapeutic potential. These findings have driven advances that, while still in their infancy, harbor important clinical implications.