Oesophageal acid clearing: One factor in the production of reflux oesophagitis

Stanciu, C; Bennett, John

doi:10.1136/gut.15.11.852

Cited by 170 publications

(49 citation statements)

References 12 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: 69%

“…18,19 In1968, Booth et al 20 developed the esophageal acid clearance test, which takes many of these factors into account by standardizing volume and pH of the bolus to be cleared. Using this test, esophageal acid clearance has been shown to be impaired in patients with EE [20][21][22] and hiatus hernia (HH), 23,24 but results from the very limited number of studies in patients with BE disagree. [25][26][27] We hypothesized that patients with BE have an impaired esophageal acid clearance compared with healthy controls.…”

Section: Introductionmentioning

confidence: 99%

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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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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: 69%

Section: Introductionmentioning

confidence: 99%

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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“…Once acid has entered the esophagus, the duration of esophageal acid exposure is determined by the effectiveness of peristalsis in removing the acid volume, along with the neutralization of any residual acid with saliva [53][54][55][56]. Infrequent peristalsis [42,57], impaired peristalsis [58], and/or diminished salivation [59,60] all can prolong esophageal acid exposure time.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Clinical Value of Esophageal Motility Testing

DiMarino

Allen²,

Lynn³

et al. 1998

Dig Dis

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Esophageal motility testing is the method of choice in evaluating esophageal motor disorders. Some physicians, however, question the clinical utility of esophageal motility testing, since the results are often normal in symptomatic patients. The clinical utility of esophageal motility testing is reviewed for patients with a complaint of noncardiac chest pain, dysphagia or symptoms of gastroesophageal reflux disease. Esophageal motility testing is particularly useful for evaluating patients with dysphagia, but less so for gastroesophageal reflux disease patients, and has little clinical utility in patients with noncardiac chest pain.

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“…It is associated with heartburn, regurgitation; usually twice weekly reflux more than several months that leads to harm the quality of life. 1,2 The impaired clearance of regurgitated gastric contents in the oesophagus is one of the risk factor of this disease 3 in association with other factors like hiatal hernia, 4 obesity, 5 and consumption of special type of foods and the effect of physical exercise. 6 One method to diagnose reflux esophagitis is endoscopy that facilitates straight visualizing changes in the gastric mucosa like gastritis and to develop an endoscopic grading system for atrophy with the use of the endoscopic atrophic border.…”

Section: Introductionmentioning

confidence: 99%