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Saliva Production and Esophageal Motility Influence Esophageal Acid Clearance Related to Post-reflux Swallow-Induced Peristaltic Wave

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Abstract

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.

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Funding

This study was funded in part by the Jewish Heritage Fund for Excellence (BDR).

Author information

Authors and Affiliations

  1. Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy

    Lorenzo Marchetti

  2. Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Ave.,, Campus Box 8124, Saint Louis, MO, 63110, USA

    Benjamin D. Rogers, Tricia Hengehold & C. Prakash Gyawali

  3. Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA

    Benjamin D. Rogers

  4. Division of Gastroenterology, Ohio State University, Columbus, OH, USA

    Tricia Hengehold

  5. Wingate Institute, Queen Mary University of London, London, UK

    Daniel Sifrim

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  1. Lorenzo Marchetti
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  2. Benjamin D. Rogers
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  5. C. Prakash Gyawali
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Contributions

Guarantor of the article: CPG. Author roles: LM, TH: data collection, data analysis, manuscript review; BDR: data analysis, manuscript preparation and review; DS, CPG: study concept, data collection and analysis, manuscript preparation and review, and critical review of the manuscript.

Corresponding author

Correspondence to C. Prakash Gyawali.

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Conflict of interest

LM, TH: no disclosures; BDR: Braintree Labs (consulting); DS: Reckkit Benkiser, UK, Jinshang China (honorarium, research grants); CPG: Consulting: Medtronic, Diversatek; speaking: Carnot.

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Marchetti, L., Rogers, B.D., Hengehold, T. et al. Saliva Production and Esophageal Motility Influence Esophageal Acid Clearance Related to Post-reflux Swallow-Induced Peristaltic Wave. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08315-x

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