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

Lorenzo Marchetti; Benjamin D Rogers; Tricia Hengehold; Daniel Sifrim; C Prakash Gyawali

doi:10.1007/s10620-024-08315-x

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

Dig Dis Sci. 2024 Mar 25. doi: 10.1007/s10620-024-08315-x. Online ahead of print.

Authors

Lorenzo Marchetti¹, Benjamin D Rogers^{2

3}, Tricia Hengehold^{2

4}, Daniel Sifrim⁵, C Prakash Gyawali⁶

Affiliations

¹ Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy.
² Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Ave.,, Campus Box 8124, Saint Louis, MO, 63110, USA.
³ Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA.
⁴ Division of Gastroenterology, Ohio State University, Columbus, OH, USA.
⁵ Wingate Institute, Queen Mary University of London, London, UK.
⁶ Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Ave.,, Campus Box 8124, Saint Louis, MO, 63110, USA. cprakash@wustl.edu.

PMID: 38528208
DOI: 10.1007/s10620-024-08315-x

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.

Keywords: Gastroesophageal reflux; High resolution manometry; Post-reflux swallow-induced peristaltic wave; pH-impedance monitoring.