I have been suffering from reflux for about 4 years and have had all the tests done (endoscopy, manometry, 24hr ph) which showed that my 60mg of dexilant is working well (pH in my esophagus and throat is 4), but that I do continue to have some reflux (though it is not acidic). I suffer mainly from throat issues, as my voice is only about 70% of where it was prior to having reflux. The ENT four years ago said my arytenoids were inflamed, but after being on the dexilant says everything looks good, though I continue to have some symptoms. Well, after reading Dr. Koufman's book, I am concerned about pepsin, and wonder if continuing to have repeated exposure to pepsin in my throat could have long-term damaging effects on my voice. Does anyone have any data or experience with this? I am seeing my ENT next week and will ask him. Thanks.