1. A patient can present with LPR like symptoms which are not necessarily caused by reflux and this is the reason why a negative pepsin result can be as important as a positive pepsin result to help us identity the reasons why patients are experiencing symptoms at that time. If you have a positive pepsin result this indicates that reflux has occurred and the reflux should be treated appropriately.
2. However a negative pepsin result in a patient with LPR like symptoms is far more challenging. The symptoms may be due to i) a previous reflux event which has damaged the sensitive epithelium cell layer of the throat, vocal cords, airways ii) this damaged area has allowed bacteria to colonise which will cause inflammation and irritation and possibly needs to be treated with antibiotics on anti-inflammatory type medication iii) the symptoms might be the result of an allergy or food intolerance and this will need investigating iv) the damage to the delicate epithelial cell lining might have been caused by smoking or alcohol or by insulting the cell lining by drinking excessively hot or acidic drinks?
3. One suggestion if symptoms persist and reflux has been ruled out by a negative Peptest result is for the patient to undergo a course of vocal/throat hygiene. A good ENT specialist can advise here or even better get in touch with a Speech Language Therapist attached to the ENT clinic.