There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Importance of Chloride in Gastric Pepsin Production
- There is no direct evidence in the provided studies that discusses the importance of chloride in gastric pepsin production and its relation to gastroesophageal reflux disease (GERD)-related heartburn 1, 2, 3, 4, 5.
Role of Pepsin in GERD
- Pepsin is considered one of the major destructive agents of GERD on the esophageal epithelium, along with gastric acid 1, 2, 4, 5.
- A study found that the highest mean gastric pepsin concentration was observed in patients with erosive reflux disease (ERD) Los Angeles (LA) grade C/D, and the lowest median gastric pH was also observed in this group 4.
- The severity of GERD disease is related to the lowest pH and the highest pepsin concentration in gastric juice 4.
Factors Influencing GERD
- Numerous factors are important in the pathophysiology of GERD, including the anti-reflux barrier, lower esophageal sphincter (LES) pressure, and gastric factors such as delayed gastric emptying and acid secretion 1, 2, 5.
- Ineffective peristalsis and impaired acid clearance are also major impairments to normal acid clearance in GERD patients 5.
- The influence of gastric colonization by Helicobacter pylori on GERD is still being understood, with some studies suggesting that it may be protective against severe esophagitis and Barrett's esophagus 5.