The Ontogeny of Saliva Secretion in Infants and Esophagoprotection

Collares, Edgard Ferro; Fernandes, Maria Inez Machado

doi:10.1590/s0004-28032015000200016

Cited by 4 publications

(4 citation statements)

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“…While we can suggest that esophageal dysmotility is resulting in inadequate clearance of the acid, it is also feasible that other acid-neutralizing mechanisms may be flawed. Such inconsistent mechanisms may include production of salivary bicarbonate, mucosal secretions, and mucosal proteins which buffer H+ ions (50). In addition to its role in buffering, salivary factors protect and repair the esophageal mucosa (50).…”

Section: Discussionmentioning

confidence: 99%

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Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

et al. 2017

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Objective To quantify and compare maximal extent (height) of acid reflux events (AREs) on symptom generation in dysphagic neonates. Methods Dysphagic neonates (N=53), born at 30 ± 5.3 wks gestation, underwent 24-hour pH-impedance study for the evaluation of troublesome symptoms purported to be due to gastroesophageal reflux disease (GERD). AREs (pH < 4 for > 4 seconds) detected by impedance (Z) were categorized by maximal extent as refluxate reaching distal (Z6, Z5), middle (Z4, Z3), or proximal (Z2, Z1) impedance channels. AREs reaching the pH sensor only were categorized as distal. Symptom correlation (%, symptom index (SI), symptom sensitivity index (SSI), and symptom associated probability (SAP)) and temporal characteristics (clearance times) of AREs were analyzed using linear mixed and GEE models comparing height categories presented as mean ± SEM, median (IQR), and OR (95% CI). Results Of the 2003 AREs: 1) distal extent AREs (n=1642) had increased frequency (p < 0.05), decreased ACT (p<0.05), and decreased acidity (p<0.05), 2) in middle and proximal AREs, acid clearance was longer than bolus clearance, p < 0.01, and 3) the odds of having cardiorespiratory (cough or sneeze) symptoms are increased with proximal and middle AREs (p<0.05). Conclusion Most proximal ascent of AREs into middle or proximal esophagus likely activates protective aerodigestive reflexes (peristalsis) or vigilant states to facilitate bolus and chemical clearance. Heightened esophageal sensitivity, acid neutralization delays, or clearance mechanism delays may accentuate multi-systemic troublesome symptoms.

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Section: Discussionmentioning

confidence: 99%

“…Such inconsistent mechanisms may include production of salivary bicarbonate, mucosal secretions, and mucosal proteins which buffer H+ ions (50). In addition to its role in buffering, salivary factors protect and repair the esophageal mucosa (50). …”

Section: Discussionmentioning

confidence: 99%

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

et al. 2017

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“…Salivary secretion per kg of body weight in the first year of life surpasses that of adults and may be offering an advantage in acid-buffering capacity and pre-epithelial esophageal defences, partially explaining the lower incidence of RE in infants. 145 Saliva plays a protective role in the development of reflux disease as it neutralizes refluxate acidity and induces wet swallows and therefore primary peristalsis. There is evidence that distal esophageal perfusion with acid is correlated with an increase in the salivary flow rate 146,147 and therefore there is an assumption that there is a reflex mechanism between acid-sensitive receptors in the distal esophagus and salivary glands.…”

Section: Chemical Clearancementioning

confidence: 99%

Section: Pathophysiology Mechanisms Involved In Reflux Event Generati...mentioning

confidence: 99%

Pathophysiology of Pediatric Gastroesophageal Reflux Disease

Nikaki

Sifrim²

2021

Journal of Clinical Gastroenterology

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Gastroesophageal reflux (GOR) is defined as "the passage of gastric contents into the esophagus with or without regurgitation and vomiting" and gastroesophageal reflux disease (GORD) is defined "when GOR leads to troublesome symptoms affecting the daily functioning and/or complications." This definition was first developed in 2006 by the Montreal consensus group (1) and later on adopted by pediatric gastroenterology societies such as ESPGHAN and NASPGHAN in 2009 (2). The definition of gastroesophageal reflux reveals little about its pathophysiology and is focused on symptomatology. In this way, it acts as an umbrella term for the multifactorial causes of the disease and the various phenotypes encountered; from functional heartburn to hypersensitive esophagus and nonerosive reflux disease, to erosive esophagitis and Barrett's esophagus. This article is devoted to the pathophysiology of pediatric GORD in comparison to adult GORD and is divided in 2 parts. In the first part, we will systematically describe the different mechanisms for the generation and clearance of reflux events, while on the second part we will discuss the mechanisms involved in symptoms generation. Finally, we will discuss the similarities and differences between pediatric and adult GORD.

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Pediatric Considerations in Clinical Pharmacology

Fonteles

2024

Contemporary Dental Pharmacology

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The Ontogeny of Saliva Secretion in Infants and Esophagoprotection

Abstract: The greater ability to secrete saliva is an important physiological condition that may protect the infant from acid/pepsin aggression to the esophagus during early stages of development.

Cited by 4 publications

References 59 publications

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

Pathophysiology of Pediatric Gastroesophageal Reflux Disease

Pediatric Considerations in Clinical Pharmacology

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