We studied clearance of acid from the esophagus and esophageal emptying in normal subjects. A 15-ml bolus of 0.1 N hydrochloric acid (pH 1.2) radiolabeled with [99mTc]sulfur colloid was injected into the esophagus, and the subject swallowed every 30 seconds. Concurrent manometry and radionuclide imaging showed nearly complete emptying of acid from the esophagus by an immediate secondary peristaltic sequence, although esophageal pH did not rise until the first swallow 30 seconds later. Esophageal pH then returned to normal by a series of step increases, each associated with a swallow-induced peristaltic sequence. Saliva stimulation by an oral lozenge shortened the time required for acid clearance, whereas aspiration of saliva from the mouth abolished acid clearance. Saliva stimulation or aspiration did not affect the virtually complete emptying of acid volume by the initial peristaltic sequence. We conclude that esophageal acid clearance normally occurs as a two-step process: (1) Virtually all acid volume is emptied from the esophagus by one or two peristaltic sequences, leaving a minimal residual amount that sustains a low pH, and (2) residual acid is neutralized by swallowed saliva.
This article has been cited by other articles:
Szczesniak, M. M., Fuentealba, S. E., Burnett, A., Cook, I. J.
(2008). Differential relaxation and contractile responses of the human upper esophageal sphincter mediated by interplay of mucosal and deep mechanoreceptor activation. Am. J. Physiol. Gastrointest. Liver Physiol.
294: G982-G988
[Abstract][Full Text]
Bredenoord, A J, Weusten, B L A M, Curvers, W L, Timmer, R, Smout, A J P M
(2006). Determinants of perception of heartburn and regurgitation. Gut
55: 313-318
[Abstract][Full Text]
Fass, R., Quan, S. F., O'Connor, G. T., Ervin, A., Iber, C.
(2005). Predictors of Heartburn During Sleep in a Large Prospective Cohort Study. Chest
127: 1658-1666
[Abstract][Full Text]
Jadcherla, S. R., Rudolph, C. D.
(2005). Gastroesophageal Reflux in the Preterm Neonate. NeoReviews
6: e87-e98
[Full Text]
Simren, M, Silny, J, Holloway, R, Tack, J, Janssens, J, Sifrim, D
(2003). Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut
52: 784-790
[Abstract][Full Text]
Shay, S. S., Bomeli, S., Richter, J.
(2002). Multichannel intraluminal impedance accurately detects fasting, recumbent reflux events and their clearing. Am. J. Physiol. Gastrointest. Liver Physiol.
283: G376-G383
[Abstract][Full Text]
Kivela, J., Parkkila, S., Parkkila, A.-K., Leinonen, J., Rajaniemi, H.
(1999). Salivary carbonic anhydrase isoenzyme VI. J. Physiol.
520: 315-320
[Abstract][Full Text]
Anggiansah, A, Taylor, G, Marshall, R E K, Bright, N F, Owen, W A, Owen, W J
(1997). Oesophageal motor responses to gastro-oesophageal reflux in healthy controls and reflux patients. Gut
41: 600-605
[Abstract][Full Text]
Mittal, R K, Chiareli, C, Liu, J, Holloway, R H, Dixon, W Jr
(1997). Atropine inhibits gastric distension and pharyngeal receptor mediated lower oesophageal sphincter relaxation. Gut
41: 285-290
[Abstract][Full Text]
Crookes, P. F., Peters, J. H., DeMeester, T. R.
(1995). Physiology of the Antireflux Barrier and Diagnostic Tests of Foregut Function. SURG INNOV
2: 10-26
[Abstract]
Feranchak, A. P., Orenstein, S. R., Cohn, J. F.
(1994). Behaviors Associated With Onset of Gastroesophageal Reflux Episodes in Infants: Prospective Study Using Split-Screen Video and pH Probe. CLIN PEDIATR
33: 654-662
[Abstract]
Pope, C. E.
(1994). Acid-Reflux Disorders. NEJM
331: 656-660
[Full Text]
Lieberman, D. A.
(1987). Medical Therapy for Chronic Reflux Esophagitis: Long-term Follow-up. Arch Intern Med
147: 1717-1720
[Abstract]
LIEBERMAN, D. A., KEEFFE, E. B.
(1986). Treatment of Severe Reflux Esophagitis with Cimetidine and Metoclopramide. ANN INTERN MED
104: 21-26
[Abstract]
Navab, F., Texter, E. C. Jr
(1985). Gastroesophageal Reflux: Pathophysiologic Concepts. Arch Intern Med
145: 329-333
[Abstract]
Miller, A. J.
(1984). A 'Supersalivation Syndrome'. JAMA
252: 3363-3363
[Abstract]
Previous
