Acid clearance and oesophageal sensitivity in patients with progressive systemic sclerosis.

Basilisco, Guido; Barbera, Roberta; Molgora, M.; Vanoli, M.; Bianchi, Paolo

doi:10.1136/gut.34.11.1487

Cited by 20 publications

(13 citation statements)

References 19 publications

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“…However, their controls were 12 and 17 years younger than patients which could possibly have confounded the results. 3,50 A positive correlation between acid clearance times obtained with the acid clearance test and ambulatory monitoring, which we could not show, has been shown by only 2 studies, 21,51 neither demonstrating this relation in patients with BE. As for our results indicating that HH presence shortens acid clearance, previous studies have shown prolonged acid clearance in HH patients.…”

Section: Discussioncontrasting

confidence: 67%

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett‘s Esophagus Than in Healthy Controls

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Krarup

Gregersen

et al. 2016

J Neurogastroenterol Motil

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Background/AimsImpaired esophageal acid clearance may be a contributing factor in the pathogenesis of Barrett's esophagus. However, few studies have measured acid clearance as such in these patients. In this explorative, cross-sectional study, we aimed to compare esophageal acid clearance and swallowing rate in patients with Barrett's esophagus to that in healthy controls. MethodsA total of 26 patients with histology-confirmed Barrett's esophagus and 12 healthy controls underwent (1) upper endoscopy, (2) an acid clearance test using a pH-impedance probe under controlled conditions including controlled and random swallowing, and (3) an ambulatory pH-impedance measurement. ResultsCompared with controls and when swallowing randomly, patients cleared acid 46% faster (P = 0.008). Furthermore, patients swallowed 60% more frequently (mean swallows/minute: 1.90 ± 0.74 vs 1.19 ± 0.58; P = 0.005), and acid clearance time decreased with greater random swallowing rate (P < 0.001). Swallowing rate increased with lower distal esophageal baseline impedance (P = 0.014). Ambulatory acid exposure was greater in patients (P = 0.033), but clearance times assessed from the ambulatory pHmeasurement and acid clearance test were not correlated (all P > 0.3). ConclusionsMore frequent swallowing and thus faster acid clearance in Barrett's esophagus may constitute a protective reflex due to impaired mucosal integrity and possibly acid hypersensitivity. Despite these reinforced mechanisms, acid clearance ability seems to be overthrown by repeated, retrograde acid reflux, thus resulting in increased esophageal acid exposure and consequently mucosal changes.

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Section: Discussioncontrasting

confidence: 67%

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett‘s Esophagus Than in Healthy Controls

Lottrup

Krarup

Gregersen

et al. 2016

J Neurogastroenterol Motil

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“…In aggregate, these observations lend support to the contention that the severity and extent of GER in patients with SSc was most closely related to the integrity of distal esophageal peristalsis, with LES hypotension being a less critical factor. These results were directly or indirectly supported by the work of others [3][4][5]. I would be interested in the authors' thoughts in these regards.…”

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confidence: 71%

Relation Between Esophageal Acid Exposure and Esophageal Peristalsis

Yarze

2008

Dig Dis Sci

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“…62 This may be due to the esophageal dilatation which increases the surface area on which acid is dispersed and neutralized. Infusion of acid in another study 63 induced symptoms for only a small fraction of the acid exposure time, confirming the poor correlation between symptoms and acid exposure. PSS patients with abnormal motility had more prolonged heartburn than those with normal motor function although the intensity was the same.…”

Section: Diagnosis Of Esophageal Dysfunctionmentioning

confidence: 79%

Esophageal Disease in Scleroderma

Ebert

2006

Journal of Clinical Gastroenterology

153

100

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Progressive systemic sclerosis (PSS) causes smooth muscle atrophy and fibrosis of the distal two-thirds of the esophagus. Motility studies show reduced-amplitude or absent peristaltic contractions in this region and normal or decreased lower esophageal sphincter pressure. Patients complain of dysphagia, heartburn, and regurgitation due to reflux and dysmotility. Complications include strictures found in 17% to 29% of patients and Barrett esophagus is 0% to 37%. Candida esophagitis is a complication of PSS not seen with non-PSS reflux. Esophageal disease correlates with pulmonary involvement but not with disease in the stomach or intestines. Whether reflux contributes to the pulmonary disease is an open question. Although manometry is the gold standard for diagnosis, cine-esophagram and scintography are only slightly less sensitive and should be considered for following the patients. Symptoms correlate poorly with evidence of esophagitis or abnormal 24-hour pH recordings. As a result, it is unclear which patients should receive acid-reducing or prokinetic medications and which medication to use. Aspiration precautions are important in those with severe esophageal dysmotility. This review of the literature highlights many areas of uncertainty in the diagnosis and treatment of esophageal disease in PSS that can be addressed in clinical studies.

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Acid clearance and oesophageal sensitivity in patients with progressive systemic sclerosis.

Abstract: This study examined the hypothesis that

Cited by 20 publications

References 19 publications

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett‘s Esophagus Than in Healthy Controls

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett‘s Esophagus Than in Healthy Controls

Relation Between Esophageal Acid Exposure and Esophageal Peristalsis

Esophageal Disease in Scleroderma

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