Q) Are there any developments in the pipeline for finding a way to naturally neutralise refluxed pepsin or even keep it bound into the stomach? The trouble with reflux is you cannot know when you are refluxing most times, so I wonder if there are windows of time where you cannot fight it with Gaviscon etc, and the damage is then done anyway?

Is there anything conclusive to show why this reflux and subsequent problem with pepsin is happening? Also, could there be more culprits than pepsin? And, if someone got a three strikes positive test for Pepsin using Peptest, does it definitely mean permanent reflux or periodic? How can one tell based on one day’s testing?

Professor Peter Dettmar says: “There are no new developments in the pipeline to naturally neutralise refluxed pepsin that we are aware of. The best way to keep pepsin in the stomach where it belongs and where its protein digestive activity is, is to suppress reflux and bind up the pepsin and prevent it entering the oesophagus and the airways. The best agent we know to do this is alginate which is the active principle present in Gaviscon. There are literature references demonstrating this activity, such as https://www.ncbi.nlm.nih.gov/pubmed/19703345.

Pathological reflux is a chronic condition and once present and diagnosed needs to be controlled firstly if possible by lifestyle changes and dietary changes, eg avoiding certain food triggers, eating smaller meals and avoiding stressful situations. This is not always easy and over the counter and prescription medicines can help to control the symptoms of reflux.

Products with a more physical mode of action can be used safely over a prolonged period of time. For example, Gaviscon which will help prevent the gastric refluxate and containing both pepsin and bile acids from being refluxed in to the oesophagus and the airways thus preventing gastro-oesophageal reflux and laryngopharyngeal reflux.

One of the reasons why individuals continue to suffer from chronic reflux and breakthrough symptoms is because they do not control lifestyle and diet which is difficult to keep under control and one relapse can lead to a return of distressing symptoms. In individuals who lead a healthy lifestyle and include regular exercise in their daily/weekly routine, they can also suffer from reflux induced by the exercise and this can often be a trigger and should be noted as such. After exercise, a reflux suppressant will help prevent and control the reflux symptoms.

The main culprits within the gastric juice are pepsin, acid and bile acids and, to a lesser extent, pancreatic enzymes, such as trypsin. There is now a lot of evidence demonstrating that pepsin is the major culprit responsible for airway reflux and laryngopharyngeal reflux (LPR) which is responsible for example for sore throats, hoarseness, voice-breaks, lump in the throat, respiratory disorders, asthmatic conditions, shortness of breath, etc.

Peptest can be used as a reflux diagnostic measure to ascertain if pepsin is present in saliva/sputum. It is recommended to provide three saliva/sputum samples taken at time points during the day which gives the best chance of identifying the presence of pepsin and this procedure has been well validated.

Peptest can also be used at later time points as a control measure to check that lifestyle and dietary measures taken are keeping reflux under control, that treatments are being effective and, also, post-surgery in those patients who have undergone a surgical procedure to control their reflux.