Document Detail

Pharyngeal swallowing. The major factor in clearance of esophageal reflux episodes.
MedLine Citation:
PMID:  8373277     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study defined the clearance mechanisms of naturally occurring reflux episodes in normal subjects and patients with gastroesophageal reflux disease. SUMMARY BACKGROUND: Previous studies on acid clearance have been performed in the laboratory setting in supine subjects using acid instillation and stationary motility. The mechanisms of clearance have not been studied using ambulatory pH and motility monitoring. METHODS: A new system capable of monitoring simultaneously for 24 hours pharyngeal pressure, esophageal motility, and pH was used to study the clearance of naturally occurring reflux episodes in 10 normal subjects and 18 patients with gastroesophageal reflux disease. Esophageal contraction waves were classified as primary (i.e., initiated by a pharyngeal swallow) and secondary (i.e., unrelated to a pharyngeal swallow). RESULTS: A total of 1288 reflux episodes were analyzed, during which 2781 contraction waves occurred. Clearance (i.e., restoration of pH to > 4) occurred after primary peristalsis in 83% of reflux episodes. An additional 11% were cleared by pharyngeal swallows without an esophageal body response. Secondary waves were rare and when they occurred, only 19% were peristaltic. Secondary peristalsis cleared only 9 of the 1288 reflux episodes. Patients and normal subjects cleared reflux episodes similarly. Baseline swallowing frequency was 0.87/min during the daytime and increased to 2.59/min (p < 0.01) during daytime reflux episodes. Swallowing frequency in response to nighttime reflux episodes was less (1.42/min; p < 0.05). CONCLUSIONS: Pharyngeal swallowing is the most important mechanism for esophageal acid clearance. Secondary waves are rare, usually disorganized, and unimportant in clearing a reflux episode. During sleep, the mechanisms of clearance are depressed.
R M Bremner; S F Hoeft; M Costantini; P F Crookes; C G Bremner; T R DeMeester
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  218     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-10-12     Completed Date:  1993-10-12     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  364-9; discussion 369-70     Citation Subset:  AIM; IM    
Department of Surgery, University of Southern California School of Medicine, Los Angeles.
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MeSH Terms
Aged, 80 and over
Deglutition / physiology*
Gastroesophageal Reflux / physiopathology*
Hydrogen-Ion Concentration
Middle Aged
Monitoring, Physiologic
Pharynx / physiology*
Sleep / physiology

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