Esophageal pH increments associated with post-reflux swallow-induced peristaltic waves show the occurrence and relevance of esophago-salivary reflex in clinical setting
Esophageal pH increments associated with post-reflux swallow-induced peristaltic waves show the occurrence and relevance of esophago-salivary reflex in clinical setting
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DOI：
10.1111/nmo.14085
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发表时间：
2021-01-20
影响因子：
3.5
通讯作者：
Savarino, Edoardo
中科院分区：
文献类型：
--
作者：
Frazzoni, Marzio;Frazzoni, Leonardo;Savarino, Edoardo
背景资料：酸灌注后，食管pH值通过吞咽含碳酸氢盐的唾液恢复，唾液是对迷走神经食管唾液反射的反应。在阻抗-pH监测中，反流后吞咽诱导的蠕动波（PSPW）指数将反流后吞咽时间与反流事件数量联系起来：低值代表反流相关胃灼热（RRH），治疗中缺乏改善代表质子泵抑制剂（PPI）治疗失败。相当大的食管pH值增量与PSPWs可以证明食管唾液反射的发生在临床环境中，而其相关性可以显示较低的食管pH值增量PPI难治性RRH.Methods：前瞻性多中心研究与PPI难治性或PPI反应性RRH患者评价关闭PPI阻抗pH监测。测量与PSPW相关的pH值增量，并计算平均值以获得PSPW相关的pH值增量。关键结果：294例RRH患者的平均PSPW相关pH值增量为1.2 +/- 0.7，137例PPI难治性（1.0 +/- 0.6）低于157例PPI应答性（1.5 +/- 0.6）病例（p < 0.0001）。在多变量logistic回归分析中，较低的PSPW相关pH增量与PPI失败独立相关（OR 0.16，95% CI 0.09-0.26）。在ROC曲线分析中，PPI无效和PPI有效病例的PSPW相关pH升高的AUC为0.76（95%CI 0.71-0.82），最佳临界值为1.2。结论：PSPW相关pH升高表明在临床环境中存在食管-唾液反射。PPI难治性RRH病例的较低增量显示了食管-唾液反射的临床相关性，证实了PSPW代表了对抗反流的防御机制。PSPW相关的pH增量可以有效地预测接受停药阻抗pH监测的患者的PPI反应。
Background: Following acid perfusion, esophageal pH is restored by swallowed bicarbonate-containing saliva secreted in response to a vagal esophago-salivary reflex. At impedance-pH monitoring, the post-reflux swallow-induced peristaltic wave (PSPW) index puts into relationship timely post-reflux swallows with the number of reflux events: Low values typify reflux-related heartburn (RRH) and lack of on-therapy improvement characterizes proton pump inhibitor (PPI) failure. Considerable esophageal pH increments associated with PSPWs could demonstrate the occurrence of esophago-salivary reflex in clinical setting, while its relevance could be shown by lower esophageal pH increments in PPI-refractory RRH.Methods: Prospective multicenter study in patients with PPI-refractory or PPI-responsive RRH evaluated with off-PPI impedance-pH monitoring. Increments in pH associated with PSPWs were measured and the mean calculated to obtain the PSPW-associated increment pH.Key Results: The mean PSPW-associated increment pH in 294 RRH patients was 1.2 +/- 0.7 and was lower in 137 PPI-refractory (1.0 +/- 0.6) than in 157 PPI-responsive (1.5 +/- 0.6) cases (p < 0.0001). Lower PSPW-associated increment pH was independently related to PPI failure at multivariable logistic regression analysis (OR 0.16, 95% CI 0.09-0.26). At ROC analysis, comparing PPI-refractory to PPI-responsive cases the AUC for PSPW-associated increment pH was 0.76 (95% CI 0.71-0.82), the best cutoff value being 1.2.Conclusions and Inferences: Considerable PSPW-associated pH increments demonstrate the occurrence of esophago-salivary reflex in clinical setting. Lower increments in PPI-refractory RRH cases show the clinical relevance of esophago-salivary reflex, confirming that PSPW represents a defense mechanism against reflux. PSPW-associated increment pH can efficiently predict PPI response in patients undergoing off-therapy impedance-pH monitoring.