Background

The post-reflux swallow-induced peristaltic wave (PSPW) brings salivary bicarbonate to neutralize residual distal esophageal mucosal acidification.

Aims

To determine if reduced saliva production and esophageal body hypomotility would compromise PSPW-induced pH recovery in the distal esophagus.

Methods

In this multicenter retrospective cross-sectional study, patients with confirmed Sjogren’s syndrome and scleroderma/mixed connective tissue disease (MCTD) who underwent high resolution manometry (HRM) and ambulatory pH-impedance monitoring off antisecretory therapy were retrospectively identified. Patients without these disorders undergoing HRM and pH-impedance monitoring for GERD symptoms were identified from the same time-period. Acid exposure time, numbers of reflux episodes and PSPW, pH recovery with PSPW, and HRM metrics were extracted. Univariate comparisons and multivariable analysis were performed to determine predictors of pH recovery with PSPW.

Results

Among Sjogren’s syndrome (n = 34), scleroderma/MCTD (n = 14), and comparison patients with reflux symptoms (n = 96), the scleroderma/MCTD group had significantly higher AET, higher prevalence of hypomotility, lower detected reflux episodes, and very low numbers of PSPW (p ≤ 0.004 compared to other groups). There was no difference in pH-impedance metrics between Sjogren’s syndrome, and comparison patients (p ≥ 0.481). Proportions with complete pH recovery with PSPW was lower in Sjogren’s patients compared to comparison reflux patients (p = 0.009), predominantly in subsets with hypomotility (p < 0.001). On multivariable analysis, diagnosis of Sjogren’s syndrome, scleroderma/MCTD or neither (p = 0.014) and esophageal hypomotility (p = 0.024) independently predicted lack of complete pH recovery with PSPW, while higher total reflux episodes trended (p = 0.051).

Conclusions

Saliva production and motor function are both important in PSPW related pH recovery.

Graphical Abstract

背景

吞咽后反流引起的蠕动波（PSPW）带来唾液碳酸氢盐来中和残留的远端食管粘膜酸化。

目标

确定唾液分泌减少和食管体运动不足是否会影响 PSPW 诱导的远端食管 pH 值恢复。

方法

在这项多中心回顾性横断面研究中，回顾性鉴定了确诊为干燥综合征和硬皮病/混合性结缔组织病 (MCTD) 的患者，这些患者在抗分泌治疗后接受了高分辨率测压 (HRM) 和动态 pH 阻抗监测。没有这些疾病的患者在同一时间段接受 HRM 和 pH 阻抗监测来检测 GERD 症状。提取酸暴露时间、反流次数和 PSPW、PSPW 的 pH 恢复以及 HRM 指标。进行单变量比较和多变量分析以确定 PSPW pH 恢复的预测因子。

结果

在干燥综合征 ( n  = 34)、硬皮病/MCTD ( n  = 14) 和有反流症状的对照患者 ( n  = 96) 中，硬皮病/MCTD 组的 AET 显着较高，运动不足的患病率较高，检测到的反流发作较低， PSPW 数量非常低（ 与其他组相比，p ≤ 0.004）。干燥综合征患者和对照患者之间的 pH 阻抗指标没有差异 ( p  ≥ 0.481)。与对照反流患者相比，PSPW 使 pH 值完全恢复的比例较低 ( p  = 0.009)，主要发生在运动不足的亚群中 ( p  < 0.001)。在多变量分析中，干燥综合征、硬皮病/MCTD 或两者都没有 ( p  = 0.014) 和食管运动不足 ( p  = 0.024) 的诊断独立预测 PSPW 无法完全恢复 pH 值，而总反流发作率较高 ( p  = 0.051)。

结论

唾液产生和运动功能对于 PSPW 相关 pH 值恢复都很重要。

图形概要