Helm J F, Dodds W J, Hogan W J
Department of Medicine, Medical College of Wisconsin, Milwaukee.
Gastroenterology. 1987 Dec;93(6):1393-7. doi: 10.1016/0016-5085(87)90270-8.
We studied the effect of esophageal acid perfusion on salivation in patients with reflux esophagitis and in normal subjects. Serial 10-min saliva collections were obtained by expectoration during perfusion of the esophagus with water, and then 0.1 N HCl (pH 1.2) for 50 min or 0.01 N HCl (pH 2.1) for 120 min. Within 1-5 min of beginning 0.1 N HCl perfusion, all 8 patients with esophagitis developed heartburn accompanied by an increase in saliva flow. By the time the severity of heartburn required discontinuation of HCl perfusion (10-40 min), saliva flow had increased nearly fourfold. With 0.1 N HCl perfusion, 8 of 10 volunteers developed mild heartburn after 22 +/- 3 min (mean +/- SE), whereas 0.01 N HCl induced heartburn in 6 of 10 volunteers after 57 +/- 12 min of perfusion. Saliva flow increased concurrently with the onset of heartburn and doubled in those volunteers who developed heartburn. Saliva flow did not change in those volunteers who were without heartburn. We conclude that esophageal acid perfusion unaccompanied by heartburn does not affect salivation. However, saliva flow increases concurrently with the onset of heartburn, a phenomenon called "water brash" when clinically evident. The increased saliva flow that accompanies heartburn may act as an endogenous antacid that serves as a protective response to symptomatic gastroesophageal reflux.
我们研究了食管酸灌注对反流性食管炎患者和正常受试者唾液分泌的影响。在用水灌注食管期间，通过咳痰连续收集10分钟的唾液，然后用0.1N盐酸（pH 1.2）灌注50分钟或用0.01N盐酸（pH 2.1）灌注120分钟。在开始0.1N盐酸灌注的1 - 5分钟内，所有8例食管炎患者均出现烧心症状，同时唾液分泌增加。当烧心严重程度需要停止盐酸灌注时（10 - 40分钟），唾液分泌量增加了近四倍。在0.1N盐酸灌注时，10名志愿者中有8名在22±3分钟（平均值±标准误）后出现轻度烧心，而在0.01N盐酸灌注时，10名志愿者中有6名在灌注57±12分钟后出现烧心。唾液分泌随着烧心的出现而增加，在出现烧心的志愿者中增加了一倍。未出现烧心的志愿者唾液分泌量没有变化。我们得出结论，无烧心症状的食管酸灌注不影响唾液分泌。然而，唾液分泌随着烧心的出现而增加，临床上明显时这种现象称为“水冲涎”。烧心时伴随的唾液分泌增加可能作为一种内源性抗酸剂，是对有症状的胃食管反流的一种保护反应。
