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Diagnosis and treatment has focused on acid, but realization of the role of nonacid reflux has resulted in research investigating the use of pepsin as a biomarker for gastric reflux and aspiration. Pepsin analysis can complement the use of questionnaires and office\u2010based diagnosis and lessen the dependency on invasive and expensive diagnostic tests. Furthermore, pepsin as a first\u2010line diagnostic biomarker has been shown to improve the accuracy of reflux diagnosis. In addition to its use as a diagnostic biomarker, pepsin has been shown to cause inflammation independent of the pH of the refluxate and thus despite acid suppression therapy. Research is ongoing to develop new therapies for airway reflux that specifically target pepsin.<\/jats:p>","DOI":"10.1111\/nyas.13729","type":"journal-article","created":{"date-parts":[[2018,5,18]],"date-time":"2018-05-18T04:56:26Z","timestamp":1526619386000},"page":"282-289","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Pepsin: biomarker, mediator, and therapeutic target for reflux and aspiration"],"prefix":"10.1111","volume":"1434","author":[{"given":"Nikki","family":"Johnston","sequence":"first","affiliation":[{"name":"Department of Otolaryngology and Communication Sciences Medical College of Wisconsin  Milwaukee Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter W.","family":"Dettmar","sequence":"additional","affiliation":[{"name":"RD Biomed Limited Castle Hill Hospital  Cottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank 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