Pepsin and bile salts

Pepsin and bile salts are the primary aggressive factors found in gastroduodenal refluxate. Pepsin is a major aspartic protease secreted by gastric chief cells as the zymogen pepsinogen, which is activated by low gastric pH to digest proteins (UniProt P00790). Bile salts are steroid acids synthesized in the liver and stored in the gallbladder, functioning as surfactants to emulsify dietary fats in the duodenum (PubChem CID 221493). In diseases like gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR), these components reflux into the esophagus and larynx, causing mucosal inflammation and cellular damage (StatPearls, Gastroesophageal Reflux Disease). Pepsin remains stable at neutral pH and can be reactivated by subsequent acid exposure, leading to chronic tissue injury. Bile salts contribute to mucosal damage by solubilizing cell membrane lipids and inducing oxidative stress (PubMed: 10419909). Therapeutic interventions target these components through physical barriers like alginates, which form a raft to prevent reflux, or through adsorbents like sucralfate that bind and neutralize them (PubMed: 11069339). Bile acid sequestrants like cholestyramine are also used to manage bile-mediated gastritis by binding bile salts in the lumen.

Other names

Gastroduodenal refluxateGastric juice componentsBile acids and pepsinRefluxate

Drugs targeting these components typically work through physical sequestration, adsorption, or pH-mediated inactivation to prevent mucosal contact and enzymatic activity.