see also:

• gastro-oesophageal reflux

• inflammation of the laryngeal and pharyngeal regions, especially near the arytenoids but also the vocal folds due to gastro-oesophageal reflux which in these patients is often silent in that it may not cause heart burn pains
• this is thought to be due to a combination of gastric pepsin and acid

• pepsin with acid refluxing up the oesophagus from the stomach into the pharynx and larynx causing inflammation
• some patients despite being on proton pump inhibitors (PPIs) develop injury to the vocal folds in laryngopharyngeal reflux primarily through direct action of refluxed pepsin from the stomach which can cause chronic vocal cord inflammation, cough, and potentially vocal cord polyps
• pepsin is produced by chief cells in the gastric glands of the stomach lining and is the main enzyme which breaks down protein in the stomach and is responsible for 10–15% of total protein hydrolysis,and works best around pH 1.5–2.5
• studies show that across pH 2–6, adding pepsin consistently produced significantly more mucosal injury than acid treatment alone, indicating that pepsin extends the damaging range of reflux into “weakly acidic” conditions

• fiberoptic confirmation of inflammation

• usual recommendation is a 3 month course of proton pump inhibitors (PPIs)