The Role of Pepsin in LPR: Will It Change Our Diagnostic and Therapeutic Approach to the Disease?

Abstract

Laryngopharyngeal reflux (LPR) is the back flow of gastric contents into the laryngopharynx. It is estimated that this disease affects 20−40 % of the United States population and is commonly encountered by otolaryngologists. Patients with LPR present with symptoms due to chronic laryngeal irritation such as hoarseness and cough. Pepsin, a gastric enzyme, has been shown to be a specific and sensitive biomarker for LPR. Measurement of pepsin in patients with LPR symptoms holds promise as a reliable diagnostic test. Studies have shown that pepsin induces cell damage, inflammation, and neoplastic changes independently of gastric acid in an endocytosis-dependent manner. Thus, pepsin has been proposed as a novel therapeutic target, especially for patients experiencing refractory symptoms on currently available anti-reflux medications. Further research is needed to elucidate the exact role that pepsin plays in inflammatory and neoplastic diseases of the laryngopharynx and to develop pharmacologic agents targeting pepsin.