Background Acid sensitivity can be altered in patients with gastroesophageal reflux disease (GERD). Secondary peristalsis helps clear gastro-esophageal refluxate and residual ingested food bolus. Objectives The aim of this study was to investigate the associations among acid sensitivity, esophageal mucosal integrity, chemical clearance, and secondary peristalsis before and after esophageal acid infusion. Design This was an investigator-initiated, prospective, cross-sectional study. Methods Adult reflux patients underwent high resolution manometry and 24 h impedance-pH monitoring off acid suppression to identify GERD phenotypes, including non-erosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH). Secondary peristalsis was assessed using five rapid 20 mL air injections into the esophagus before and after infusion of hydrochloric acid (0.1 N) into the mid-esophagus. Conventional acid infusion parameters recorded included lag time, intensity rating, and sensitivity score. Chemical clearance was evaluated using the post-reflux swallow-induced peristaltic wave (PSPW), and mucosal integrity was assessed by the mean nocturnal baseline impedance (MNBI) derived from impedance-pH monitoring. Results A total of 88 patients (age 21-64 years, 62.5% women) completed the study including 12 patients with NERD, 45 with RH, and 31 with FH. There was no significant difference in acid infusion parameters between patients with NERD, RH, and FH. Upon acid infusion, patients who exhibited successful secondary peristalsis had longer lag time, higher MNBI, and shorter bolus contact time than those without secondary peristalsis. Meanwhile, patients with intact PSPW demonstrated significantly higher intensity ratings in response to acid perfusion and higher MNBI than those with impaired PSPW. The lag time correlated positively with MNBI (r = 0.285; p = 0.007). Conclusion In conclusion, the protective effect of esophageal secondary peristalsis and chemical clearance on esophageal mucosal integrity was demonstrated. Concerning acid sensitivity, longer lag time in patients with intact secondary peristalsis may be attributed to better esophageal mucosal integrity, while stronger intensity ratings may have a greater tendency to induce PSPW and protect esophageal mucosal integrity.

中文翻译：

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胃食管反流病患者输酸和化学清除后的食管二次蠕动与粘膜完整性和酸敏感性相关。

背景 胃食管反流病 (GERD) 患者的酸敏感性可能会发生改变。二次蠕动有助于清除胃食管反流物和残留摄入的食物团。目的 本研究的目的是探讨食管酸输注前后酸敏感性、食管粘膜完整性、化学清除率和二次蠕动之间的关联。设计 这是一项由研究者发起的前瞻性横断面研究。方法 成人反流患者接受高分辨率测压和 24 小时阻抗-pH 监测，以识别 GERD 表型，包括非糜烂性反流病 (NERD)、反流过敏 (RH) 和功能性胃灼热 (FH)。在将盐酸 (0.1 N) 注入食管中部之前和之后，通过向食管中快速注射 5 次 20 mL 空气来评估二次蠕动。记录的常规酸输注参数包括滞后时间、强度等级和敏感性评分。使用反流后吞咽引起的蠕动波（PSPW）评估化学清除率，并通过阻抗-pH监测得出的平均夜间基线阻抗（MNBI）评估粘膜完整性。结果 共有 88 名患者（年龄 21-64 岁，62.5% 女性）完成了研究，其中 NERD 患者 12 名，RH 患者 45 名，FH 患者 31 名。NERD、RH 和 FH 患者之间的酸输注参数没有显着差异。输注酸后，表现出成功的二次蠕动的患者具有更长的滞后时间、更高的 MNBI、与没有二次蠕动的相比，丸剂接触时间更短。同时，与 PSPW 受损的患者相比，PSPW 完整的患者对酸灌注的反应强度等级显着更高，并且 MNBI 更高。滞后时间与 MNBI 呈正相关（r = 0.285；p = 0.007）。结论 总之，食管二次蠕动和化学清除对食管粘膜完整性的保护作用得到证实。关于酸敏感性，二次蠕动完整的患者较长的滞后时间可能归因于更好的食管粘膜完整性，而较强的强度等级可能更容易诱导 PSPW 并保护食管粘膜完整性。与 PSPW 受损的患者相比，PSPW 完整的患者对酸灌注的反应强度等级显着更高，并且 MNBI 更高。滞后时间与 MNBI 呈正相关（r = 0.285；p = 0.007）。结论 总之，食管二次蠕动和化学清除对食管粘膜完整性的保护作用得到证实。关于酸敏感性，二次蠕动完整的患者较长的滞后时间可能归因于更好的食管粘膜完整性，而较强的强度等级可能更有可能诱导 PSPW 并保护食管粘膜完整性。与 PSPW 受损的患者相比，PSPW 完整的患者对酸灌注的反应强度等级显着更高，并且 MNBI 更高。滞后时间与 MNBI 呈正相关（r = 0.285；p = 0.007）。结论 总之，食管二次蠕动和化学清除对食管粘膜完整性的保护作用得到证实。关于酸敏感性，二次蠕动完整的患者较长的滞后时间可能归因于更好的食管粘膜完整性，而较强的强度等级可能更有可能诱导 PSPW 并保护食管粘膜完整性。食管二次蠕动和化学清除对食管粘膜完整性的保护作用得到了证实。关于酸敏感性，二次蠕动完整的患者较长的滞后时间可能归因于更好的食管粘膜完整性，而较强的强度等级可能更有可能诱导 PSPW 并保护食管粘膜完整性。食管二次蠕动和化学清除对食管粘膜完整性的保护作用得到了证实。关于酸敏感性，二次蠕动完整的患者较长的滞后时间可能归因于更好的食管粘膜完整性，而较强的强度等级可能更有可能诱导 PSPW 并保护食管粘膜完整性。