Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy.
Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Ave.,, Campus Box 8124, Saint Louis, MO, 63110, USA.
Dig Dis Sci. 2024 May;69(5):1714-1721. doi: 10.1007/s10620-024-08315-x. Epub 2024 Mar 25.
The post-reflux swallow-induced peristaltic wave (PSPW) brings salivary bicarbonate to neutralize residual distal esophageal mucosal acidification.
To determine if reduced saliva production and esophageal body hypomotility would compromise PSPW-induced pH recovery in the distal esophagus.
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.
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).
Saliva production and motor function are both important in PSPW related pH recovery.
反流后吞咽诱导的蠕动波（PSPW）可使唾液碳酸氢盐中和残余远端食管黏膜酸化。
确定唾液生成减少和食管体动力不足是否会影响 PSPW 在远端食管诱导的 pH 恢复。
在这项多中心回顾性交叉研究中，回顾性鉴定了接受高分辨率测压（HRM）和抗分泌治疗下动态 pH 阻抗监测的确诊干燥综合征和硬皮病/混合性结缔组织病（MCTD）患者。同时，还从同一时期确定了无这些疾病但因 GERD 症状而接受 HRM 和 pH 阻抗监测的患者。提取酸暴露时间、反流事件次数和 PSPW、PSPW 时的 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 时 pH 恢复的预测因素。
在干燥综合征组（n=34）、硬皮病/MCTD 组（n=14）和有反流症状的对照组患者（n=96）中，硬皮病/MCTD 组的 AET 显著更高、动力障碍的患病率更高、检测到的反流事件更少、PSPW 非常少（与其他组相比，p≤0.004）。干燥综合征组和对照组的 pH 阻抗指标无差异（p≥0.481）。与对照组反流患者相比，干燥综合征患者 PSPW 时完全 pH 恢复的比例较低（p=0.009），主要在动力障碍亚组中（p<0.001）。多变量分析显示，干燥综合征、硬皮病/MCTD 或两者均无诊断（p=0.014）和食管动力障碍（p=0.024）独立预测 PSPW 时无完全 pH 恢复，而总反流事件较高呈趋势（p=0.051）。
唾液产生和运动功能在 PSPW 相关 pH 恢复中均很重要。
