Unfortunately, such surgery carries no guarantees of long-term success. “More than half of the patients in the Kerschner study who had undergone anti-reflux surgery actually had detectable levels of pepsin in their tracheas, presumably because those fundoplication wraps were breaking down over time and were not preventing reflux,” Dr. Bishop said. “So this is a definite challenge we all face in managing these patients.”
Explore this issue:
December 2013How about some type of treatment targeted to pepsin itself? That’s a somewhat tricky proposition, said Dr. Kerschner. “There’s really no ‘anti-pepsin’ medication that directly counteracts its effects, but evidence suggests that pepsin tends to be reactivated at lower pH levels, so counteracting those lower pHs with acid suppression therapy may actually have some beneficial effects.”
Dr. Kerschner added, “We are also working in our lab on a more direct approach—that is, treatments that actually do counteract pepsin activation. But we’re quite a ways off from bringing that to fruition.”
Nancy Bauman, MD, a pediatric otolaryngologist at Children’s National Medical Center in Washington, DC, and an ENTtoday editorial board member, noted that regardless of where pepsin originates, “once it gets into the upper airway, the enzyme can do considerable damage.” Thus, the paper by Kerschner and colleagues “really has the potential to be seminal; this could bring about a significant change in how we view the role of extraesophageal reflux in chronic lung disease, how we diagnose the condition and, hopefully, how we treat it.”—DB