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A client came to me after two years on a PPI. Her ENT scoped her twice, told her the reflux was controlled, increased her dose. The hoarseness didn't quit. The piece nobody had talked about was pepsin. And it changed the entire direction of her protocol once we understood it. Here's what the research actually shows: Pepsin is taken up directly into laryngeal epithelial cells by receptor-mediated endocytosis — it doesn't just pass through, it embeds in the tissue (Johnston et al., 2010). PPIs red
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