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When one's stomach contents enter one's esophagus, a burning sensation usually ensues. Is this from the enzyme pepsin breaking apart your cells or just from the acid?

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Pepsin is a protein breaking enzyme which is most active in acidic pH. Stomach is protected from its effect by mucus, but oesophagus and larynx don't have much mucus so pepsin reflux will cause injury. So burning sensation is from both acid and pepsin.

{In contrast, if pepsin refluxes into the oesophagus and above it is damaging as there is no protective mucus layer and also the squamous tissue (the cells that line the oesophagus) is more sensitive. Research has shown that the surface cells of the larynx and airways are even more sensitive than the oesophagus to injury by reflux and pepsin specifically.} ( an excerpt from https://www.peptest.co.uk/reflux-the-role-of-pepsin-explained/ )

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  • $\begingroup$ Your source is a for-profit advert for a diagnostic test that measures pepsin. For profit sites are not a reliable source of information. It's true that pepsin most likely damages the larynx, but it's role in the pathophysiology of "heartburn" (typical reflux pain) has not been proven. $\endgroup$ – anongoodnurse Jul 31 '17 at 3:11
  • $\begingroup$ Read this hindawi.com/journals/ijoto/2012/646901 Don't say that this is also for profit. Do you have any proof for your claim? $\endgroup$ – Test_1 Jul 31 '17 at 3:42
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    $\begingroup$ Yes, I do, but commenters don't need to prove they are correct. I actually read that paper you linked to in the comment before you commented; did you? It discusses the role of pepsin in damage of various kinds but not in symptomatology. $\endgroup$ – anongoodnurse Jul 31 '17 at 4:05
  • $\begingroup$ Its damaging along with acid so the burning sensation is cumulative. DO you have any proof for your claim? $\endgroup$ – Test_1 Jul 31 '17 at 4:07
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    $\begingroup$ Again, yes, I do. Your comment is only your opinion; your link doesn't support it. Did you know that a lot of GERD is painless? Sometimes the only symptom is a cough. I suspect pepsin may have something to do with that. Other non-pain symptoms also occur. Yet the acid (and pepsin) is there. Hmm. $\endgroup$ – anongoodnurse Jul 31 '17 at 5:15
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It is the acid that causes the burn

Medicines like proton pump inhibitors (e.g. Prilosec), or H2 receptor antagonists (like Zantac) that reduce acid secretion reduce the burning sensation. Medicines that neutralize the acid like calcium carbonate (e.g. Tums) also reduce the burn. These medicines do nothing to the secretion of enzymes.

ADDENDUM. @anongoodnurse wants references. Maybe in exchange she will remove that pesky down vote.

Cimetidine won the team that developed it the Nobel prize - the first rationally (as opposed to empirically) designed drug. It was designed to very specifically reduce stomach acid.

https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/cimetidinetagamet.html

Smith Kline & French's multidisciplinary research team first looked at the physiological cause of acid secretion. They confirmed that a molecule found in the body called histamine triggers the release of acid when it binds to a specific receptor (now called the H2-receptor) in the stomach lining. Their aim was to find a molecule that successfully competed with histamine in combining with the receptor, but then blocked, rather than stimulated, acid release. Such a molecule was called a histamine H2-receptor antagonist and represented a new class of drugs.

This and the successor class of drugs (proton pump inhibitors) are very specifically designed to decrease acid secretion and do little else.

The fact that billions of dollars worth of these drugs are sold means that persons suffering from reflux pain / stomach ulcer perceive that their pain is reduced by a decrease in acid secretion, and so are willing to pay.

Tagamet® was greeted with great enthusiasm by doctors and patients alike. Ten years after its introduction, it had achieved sales of one billion dollars and had become the world's number one prescription drug.

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    $\begingroup$ You need a source for this answer, and truthfully, the pathophysiology of reflux pain is incompletely understood. $\endgroup$ – anongoodnurse Jul 31 '17 at 3:01
  • $\begingroup$ @anongoodnurse - adequate references? $\endgroup$ – Willk Aug 2 '17 at 15:29
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    $\begingroup$ I didn't DV! Thought about it but didn't; commented instead. That's the problem with commenting when there's a down vote. :( People make assumptions. (I did DV the other posted answer, however.) But good job adding sources! $\endgroup$ – anongoodnurse Aug 2 '17 at 16:22
  • $\begingroup$ Actually, I also just decided to upvote because of the improvement of the answer. (I still maintain that the pathophysiology of reflux pain is incompletely understood.) But still, did not DV. Therefore my UV only counters one DV. $\endgroup$ – anongoodnurse Aug 2 '17 at 17:03
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    $\begingroup$ @sorry anongoodnurse. Actions of any kind are sparse on these bio stack questions and I jumped to conclusion. BTW: I appreciate the double entendre in your moniker. $\endgroup$ – Willk Aug 2 '17 at 19:11

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