Rogers B, Hengehold T, Marchetti L, Sifrim D, Gyawali CP. The role of saliva production and esophageal motor function in post-reflux swallow induced peristaltic wave (PSPW) related esophageal acid clearance. UEG Jour. Poster Presentations. 2023.11(S8):594

Авторы: Rogers B.D. / Hengehold T. / Marchetti L.  / Sifrim D. / Gyawali C.P. / Юрченко М.М.

The role of saliva production and esophageal motor function in post-reflux swallow induced peristaltic wave (PSPW) related esophageal acid clearance

¹ Washington University in St. Louis, Gastroenterology, Louisville, United States,
² The Ohio State University, Gastroenterology, Columbus, United States,
³ Campus Bio-Medico Roma, Roma, Italy,
⁴ Queen Mary University London, Blizard Institute, Wingate Institute, London, United Kingdom,
⁵ Washington University School of Medicine, Division of Gastroenterology, St Louis, United States


Contact E-Mail Address: benjamindalerogers@ gmail.com

Introduction: The post reflux swallow-induced peristaltic wave (PSPW) brings salivary bicarbonate via an esophago-salivary reflex to neutralize residual esophageal mucosal acidification after gastro-esophageal reflux episodes.

Aims & Methods: We hypothesized that reduced saliva in Sjogren’s syndrome and hypomotility in both Sjogren’s syndrome and scleroderma/ mixed connective tissue disease (MCTD) could compromise PSPW-induced pH recovery in the distal esophagus. Patients with confirmed Sjogren’s syndrome and scleroderma/MCTD (based on rheumatologic evaluation) who underwent high resolution manometry (HRM) and ambulatory pH-impedance monitoring off antisecretory therapy were retrospectively identified over a 5-year period at 2 motility centers.

For comparison, patients without these disorders undergoing HRM and pH-impedance monitoring for GERD symptoms were identified from the same time-period, segregated into two groups based on presence or absence of ineffective esophageal motility (IEM).

Patients with prior foregut surgery, studies with artifacts precluding reflux episode and PSPW identification, and unconfirmed rheumatologic diagnoses were excluded. Acid exposure time (AET), numbers of reflux episodes and PSPW (using Wingate Consensus criteria), pH recovery with PSPW, and HRM metrics were compared between Sjogren’s syndrome, scleroderma/MCTD and comparison groups.

Univariate comparisons and multivariable analysis were performed to determine predictors of PSPW and pH recovery.

Results: We studied 34 patients with Sjogren’s syndrome, 14 with scleroderma/ MCTD, 96 comparison patients with reflux symptoms (49 without IEM, and 47 with IEM, Table). Age and gender distribution were similar across groups. The scleroderma/MCTD group had higher AET, higher prevalence of hypomotility, lower detected reflux episodes from very low baseline impedance, and very low numbers of PSPW (p≤0.004 compared to other groups).

	Sjogren’s syndrome n=34	Scleroderma/ MCTD n=14	Comparison reflux patients n=96	p value across groups
Total AET (%)	3.2 (0.5-10.8)	13.2 (2.9-40.1)	3.5 (1.5-7.1)	0.017
Reflux episodes	26.5 (14.0-46.5)	9.5 (1.5-20.5)	34.5 (16.0-46.8)	0.003
PSPW	6.0 (3.0-11.0)	0.0 (0.0-6.0)	7.0 (2.0-12.0)	0.010
PSPWI (%)	21.7 (14.5-46.3)	8.3 (0.0-33.0)	21.2 (13.7-36.1)	0.160
Partial pH recovery (%)	11.3 (0.0-35.6)	11.1 (0.0-49.2)	10.7 (0.0-33.3)	0.765
Complete pH recovery (%)	38.1 (0.0-61.9)	8.1 (0.0-29.2)	55.6 (33.3-71.4)	0.002
Esophageal hypomotility	8 (23.6%)	11 (78.5%)	47 (49.0%)	<0.001
IEM	4 (11.8%)	1 (7.1%)	42 (43.8%)	<0.001
Absent contractility	4 911.8%)	10 (71.4%)	5 (5.2%)	<0.001

Values are described as median (interquartile range) or values (percent)


There was no difference in pH impedance metrics between Sjogren’s syndrome, and comparison patients (p≥0.481), including between subsets of Sjogren’s and comparison patients with and without hypomotility (p≥0.116 for each comparison).

In contrast, 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). Within Sjogren’s syndrome, absent contractility was associated with rates of complete pH recovery with PSPW similar to scleroderma/MCTD (0.0% vs. 8.1% respectively, p=ns), while Sjogren’s with IEM resembled comparison patients with IEM (p=ns) although numbers were small.

On multivariable analysis including variables of interest (total reflux episodes, PSPW index, AET, and diagnosis) only higher total reflux episodes (p=0.028) and diagnosis of Sjogren’s syndrome (p=0.034) independently predicted lack of complete pH recovery with PSPW, while failed and ineffective swallows and AET were not predictive.

Conclusion: Saliva production may be more important than motor function in PSPW related pH recovery.

Disclosure: Nothing to disclose.

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Rogers B, Hengehold T, Marchetti L, Sifrim D, Gyawali CP. The role of saliva production and esophageal motor function in post-reflux swallow induced peristaltic wave (PSPW) related esophageal acid clearance. United European Gastroenterology Journal. 2023. V. 11(S8). Poster Presentations. PP0108. P.594.

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Сокращённый перевод (М. Юрченко):

Роль слюны и моторной функции пищевода в очищении пищевода от кислого рефлюксата, характеризуемого индексом пострефлюксной глоток-индуцированной перистальтической волны (PSPW)

Перистальтическая волна, индуцированная глотанием после рефлюкса, доставляет бикарбонат слюны, нейтрализующий остаточное закисление слизистой оболочки пищевода.

Было сделано предположение, что уменьшение количества слюны при синдроме Шегрена и гипомоторика как при синдроме Шегрена, так и при склеродермии/смешанном заболевании соединительной ткани могут поставить под угрозу восстановление уровня кислотности в пищеводе. Пациенты с подтвержденным синдромом Шегрена и склеродермией/смешанном заболевании соединительной ткани (на основании ревматологического обследования), которым была проведена эзофагоманометрия и pH-импедансометрия после антисекреторной терапии, были ретроспективно идентифицированы в течение 5-летнего периода.

Анализ пищеводного клиренса (очистка пищевода от рефлюксата) проводился на основе расчётов индекса пострефлюксной глоток-индуцированной перистальтической волны (post-reflux swallow-induced peristaltic wave, PSPW).

Вывод: в очистке от кислого рефлюксата и восстановления уровня рН в пищеводе слюноотделение представляется более важным, чем двигательная функция пищевода.

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Другие материалы из этого выпуска UEG Journal (все, кроме работы Valitova E, et al, сопровождаются переводами на русский язык):

• Valitova E, Bordin D, Berezina O, Chebotareva M, Baymakanova G. The diagnosis of laryngopharyngeal reflux in patients with extraesophageal symptoms of GERD. United European Gastroenterology Journal. 2023. V. 11(S8). Poster Presentations. PP0120. P.600-601


• Calabrese F, Pasta A, Giannini EG, Della Casa D, Cataudella G, Frazzoni M, Savarino EV, Penagini R, De Bortoli N, Savarino V, Marabotto E. The role of laryngoscopy in GERD patients with atypical symptoms - a multicentre study. United European Gastroenterology Journal. 2023. V. 11(S8). Poster Presentations. PP0118. P.599.


• de Bortoli N, Baiano Svizzero F, Visaggi P, Adamo G, Mariani L, Ovidi F, Stefani Donati D, Dulmin I, Venturini A, Buselli I, Scaramuzza G, Bellini M, Savarino EV. Baseline anxiety scores predict escalation to higher doses of paroxetine in patients with functional heartburn and reflux hypersensitivity. United European Gastroenterology Journal. 2023. V. 11(S8). Poster Presentations. PP0087. P. 583.

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Подборка статей с аннотациями на русском языке: Современные достижения зарубежной гастроэнтерологии.

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