PMID- 33471424
OWN - NLM
STAT- MEDLINE
DCOM- 20220118
LR  - 20220118
IS  - 1365-2982 (Electronic)
IS  - 1350-1925 (Linking)
VI  - 33
IP  - 7
DP  - 2021 Jul
TI  - Esophageal pH increments associated with post-reflux swallow-induced peristaltic 
      waves show the occurrence and relevance of esophago-salivary reflex in clinical 
      setting.
PG  - e14085
LID - 10.1111/nmo.14085 [doi]
AB  - 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 
      ∆pH. KEY RESULTS: The mean PSPW-associated ∆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 ∆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 ∆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 ∆pH can efficiently predict PPI response in 
      patients undergoing off-therapy impedance-pH monitoring.
CI  - (c) 2021 John Wiley & Sons Ltd.
FAU - Frazzoni, Marzio
AU  - Frazzoni M
AUID- ORCID: 0000-0002-8608-1563
AD  - Digestive Pathophysiology Unit and Digestive Endoscopy Unit, Baggiovara Hospital, 
      Modena, Italy.
FAU - Frazzoni, Leonardo
AU  - Frazzoni L
AD  - Gastroenterology Unit, Department of Medical and Surgical Sciences, University of 
      Bologna, Bologna, Italy.
FAU - Ribolsi, Mentore
AU  - Ribolsi M
AUID- ORCID: 0000-0001-5102-1758
AD  - Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, 
      Italy.
FAU - De Bortoli, Nicola
AU  - De Bortoli N
AUID- ORCID: 0000-0003-1995-1060
AD  - Department of Translational Research and New Technology in Medicine and Surgery, 
      University of Pisa, Pisa, Italy.
FAU - Tolone, Salvatore
AU  - Tolone S
AUID- ORCID: 0000-0002-1653-9903
AD  - General and Bariatric Surgery Unit, Department of Surgery, 2nd University of 
      Naples, Napoli, Italy.
FAU - Conigliaro, Rita
AU  - Conigliaro R
AD  - Digestive Pathophysiology Unit and Digestive Endoscopy Unit, Baggiovara Hospital, 
      Modena, Italy.
FAU - Arsie, Elena
AU  - Arsie E
AD  - Department of Pathophysiology and Transplantation, University of Milan, Milano, 
      Italy.
AD  - Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
FAU - Penagini, Roberto
AU  - Penagini R
AUID- ORCID: 0000-0001-6918-9479
AD  - Department of Pathophysiology and Transplantation, University of Milan, Milano, 
      Italy.
AD  - Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
FAU - Cicala, Michele
AU  - Cicala M
AD  - Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, 
      Italy.
FAU - Savarino, Edoardo
AU  - Savarino E
AD  - Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, 
      University of Padua, Padova, Italy.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20210120
PL  - England
TA  - Neurogastroenterol Motil
JT  - Neurogastroenterology and motility
JID - 9432572
SB  - IM
MH  - Adult
MH  - Aged
MH  - Deglutition/physiology
MH  - Electric Impedance
MH  - Esophagus/*physiology
MH  - Female
MH  - Gastroesophageal Reflux/*physiopathology
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Male
MH  - Manometry
MH  - Middle Aged
MH  - Peristalsis/*physiology
MH  - Reflex/*physiology
MH  - Saliva/*chemistry
MH  - Vagus Nerve/physiology
OTO - NOTNLM
OT  - gastroesophageal reflux disease
OT  - post-reflux swallow-induced peristaltic wave
OT  - proton pump inhibitor
EDAT- 2021/01/21 06:00
MHDA- 2022/01/19 06:00
CRDT- 2021/01/20 12:26
PHST- 2020/12/23 00:00 [revised]
PHST- 2020/11/03 00:00 [received]
PHST- 2021/01/04 00:00 [accepted]
PHST- 2021/01/21 06:00 [pubmed]
PHST- 2022/01/19 06:00 [medline]
PHST- 2021/01/20 12:26 [entrez]
AID - 10.1111/nmo.14085 [doi]
PST - ppublish
SO  - Neurogastroenterol Motil. 2021 Jul;33(7):e14085. doi: 10.1111/nmo.14085. Epub 
      2021 Jan 20.