Pepsin is inactive within the stomach until it’s woken up by acidic foods. Once activated and assimilated into gastric acid, it can surge back up into the esophagus, chest, vocal cords, and throat area— made much worse if you have loosened esophageal sphincters.
--- I'm not sure I understand. What is "made much worse"? Does it mean "the situation is even worse when you have loosened esophageal sphincters"?
Newguest Does it mean "the situation is even worse when you have loosened esophageal sphincters"? The original is not well written, but your interpretation is correct.
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NewguestDoes it mean "the situation is even worse when you have loosened esophageal sphincters"?
The original is not well written, but your interpretation is correct.