@mollypelletier.rd: That constant throat clearing? Acid gets all the blame. But the real driver is an enzyme called pepsin. Most people assume throat clearing, hoarseness, and that "lump in your throat" feeling are caused by acid splashing upward. And acid can play a role. But the research points to pepsin as the primary agent of tissue damage in your larynx and upper airway. Here's what makes pepsin so different from acid. Pepsin is a protein-digesting enzyme produced in your stomach. When it travels upward with refluxate, it makes contact with laryngeal tissue that was never designed to handle it. Your stomach has a thick protective mucus layer. Your throat does not. So when pepsin lands on laryngeal tissue, there's no built-in barrier protecting you. And here's the part that changes how you think about reflux treatment: pepsin stays enzymatically active at a pH up to 6.5, and remains stable at neutral pH (7.4) for over 24 hours. Even after the reflux episode ends, pepsin is still sitting on your tissue. And it can be reactivated the next time pH drops. One reflux event can set up tissue damage that continues for hours or days (Johnston et al., 2007, The Laryngoscope, PMID: 17417109). It gets more complex. Researchers found that pepsin is actually taken up into laryngeal cells through receptor-mediated endocytosis. Once inside the cell, pepsin is stored in low-pH compartments like endosomes and Golgi vesicles, where it regains its proteolytic activity and causes intracellular damage, including mitochondrial and Golgi complex injury (Johnston et al., 2009, Annals of Otology, Rhinology & Laryngology, PMID: 19810610). This is why acid suppression alone often doesn't resolve LPR symptoms. You can lower the acid, but pepsin is still there, still stable, still being reactivated with every minor pH fluctuation. Addressing pepsin means looking at your full reflux architecture: LES pressure, reflux event frequency, mucosal resilience, and how you support the tissue that's already been exposed. Check the link in bio for the free Reflux Relief Quiz to find out which root contributors are driving your symptoms. Follow for more and share this with someone who's been throat clearing for months without answers. #acidreflux #gerd #lpr #silentreflux #pepsin

Molly | The Reflux Dietitian

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Thursday 28 May 2026 14:03:36 GMT