Modulation of salivation and heartburn in response to the site of acid infusion in the human oesophagus

Dutta, Sudhir K.; Agrawal, K.; Mahʼmoud, Mitchell

doi:10.1111/j.1365-2036.2010.04397.x

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Acid contact on the mucosa in the distal esophagus (near the gastroesophageal junction) during the waking state induces increased salivary flow and swallowing mechanisms (primary peristalsis), and localized esophageal peristalsis (secondary peristalsis) to buffer the acid and facilitate volumetric clearance [12, 27]. These antireflux protective mechanisms also occur during sleep, but at a diminished level.…”

Section: Pathophysiology Of Gastroesophageal Reflux Diseasementioning

confidence: 99%

Gastroesophageal Reflux Disease and Tooth Erosion

Ranjitkar

Kaidonis

Smales

2012

International Journal of Dentistry

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The increasing prevalence of gastroesophageal reflux disease (GERD) in children and adults, and of “silent refluxers” in particular, increases the responsibility of dentists to be alert to this potentially severe condition when observing unexplained instances of tooth erosion. Although gastroesophageal reflux is a normal physiologic occurrence, excessive gastric and duodenal regurgitation combined with a decrease in normal protective mechanisms, including an adequate production of saliva, may result in many esophageal and extraesophageal adverse conditions. Sleep-related GERD is particularly insidious as the supine position enhances the proximal migration of gastric contents, and normal saliva production is much reduced. Gastric acid will displace saliva easily from tooth surfaces, and proteolytic pepsin will remove protective dental pellicle. Though increasing evidence of associations between GERD and tooth erosion has been shown in both animal and human studies, relatively few clinical studies have been carried out under controlled trial conditions. Suspicion of an endogenous source of acid being associated with observed tooth erosion requires medical referral and management of the patient as the primary method for its prevention and control.

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Section: Pathophysiology Of Gastroesophageal Reflux Diseasementioning

confidence: 99%

Gastroesophageal Reflux Disease and Tooth Erosion

Ranjitkar

Kaidonis

Smales

2012

International Journal of Dentistry

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“…The sensitivity to acid has been suggested to differ between the upper and lower esophageal mucosa in studies that utilized acid infusion in the esophagus 5,6. To the best of our knowledge, this is the first study to demonstrate a relationship between pH changes in different sites of the esophagus and generation of GERD symptoms during acid infusion in the upper and lower esophagus.…”

Section: Discussionmentioning

confidence: 90%

“…Therefore, the sensitivity to heartburn, chest pain, and chest oppression in the esophageal mucosa of the upper esophagus is considered to be greater than that in lower esophagus, as previous studies have also suggested 1-6. In rats, a denser supply of vagal mucosal afferent fibers was found in the upper esophagus, while sensory signals detected by specialized sensory structures were reported to travel mainly through the superior laryngeal nerve to their perikarya located in the cranial part of the vagal sensory ganglionic complex 9.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous studies that utilized 24-hour esophageal multiple pH monitoring and impedance-pH monitoring, the sensitivity of the upper and lower esophageal mucosa to gastroesophageal acid reflux is considered to differ, resulting in different symptom severity depending on the level reached by reflux contents 1-4. Acid infusion from an intra-luminal catheter at different sites of the esophagus also demonstrated that the sensitivity to acid is different in different parts of the esophagus 5,6. However, pH changes in different sites of the esophagus during acid infusion have not been investigated, nor has the co-relationship between intra-esophageal acidity and GERD symptoms during acid infusion been studied.…”

Section: Introductionmentioning

confidence: 99%

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Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults

Ohara

Furuta

Adachi

et al. 2013

J Neurogastroenterol Motil

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Background/AimsThe sensitivity of the upper and lower esophageal mucosa to acid is considered to differ. We investigated the relationship between pH changes in different sites of the esophagus and generation of gastroesophageal reflux symptoms during an acid infusion test.MethodsAn acid infusion catheter was placed at 5 or 15 cm above the lower esophageal sphincter (LES) in 18 healthy volunteers, while a 2-channel pH sensor catheter was also placed in each with the sensors set at 5 and 15 cm above the LES. Solutions containing water and hydrochloric acid at different concentrations were infused through the infusion catheter.ResultsAcid infusion in the upper esophagus caused a pH drop in both upper and lower esophageal sites, whereas that in the lower esophagus resulted in a significant pH drop only in the lower without a corresponding pH decline in the upper esophagus. Stronger heartburn, chest pain, and chest oppression symptoms were noted when acid was infused in the upper as compared to the lower esophagus, while increased intra-esophageal acidity strengthened each symptom. Regurgitations caused by upper and lower esophageal acid infusions were similar, and not worsened by a larger drop in intra-esophageal pH. Chest pain was caused only by lowered intra-esophageal pH, while heartburn, chest oppression, and regurgitation were induced by a less acidic solution.ConclusionsHigher intra-esophageal acidity caused stronger heartburn, chest pain, and chest oppression symptoms. However, regurgitation was not significantly influenced by intra-esophageal acidity. The upper esophagus showed higher acid sensitivity than the lower esophagus.

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“…It has been reported that a significant increase in heartburn occurs when acid reaches the upper area of the esophagus [32,41]. Hence, in patients with reflux where the acid does not reach the upper area of the esophagus, a reflexive increase in saliva production may not be initiated.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Effect on Acid Reflux Symptoms Occurring during Sleep of an Oral Adhering Disc Containing only Food Ingredients

Burgess¹,

Kärcher²

2017

J Gastrointest Dig Syst

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The aim of this double-blinded, randomized, controlled study was to determine if OraCoat XyliMelts, an over the counter, dissolvable, adhering disc used to reduce excessive day time or night time dry mouth by increasing salivation, would also reduce reflux and heartburn symptoms occurring during sleep among subjects suffering from both GERD and xerostomia. Subjects submitted 14 days of baseline data by answering questions and were then randomized into one of two groups: one receiving a dry mouth gel (control) and a second receiving a disc (product of interest). Neither the identities of the two products nor the manufacturers of the products was revealed to subjects. Answers to the same set of questions were then collected for an additional 14 days as the supplied products were used. The accumulated data were evaluated for pre-post treatment changes within and between groups. Variables included reported heartburn, reflux, reflux taste, hoarseness, dry mouth, and antacid use. The results showed a significant decrease in the severity of the above symptoms of GERD with both disc and gel use, although improvement was greatest for those using the discs. Comparison between the gel and disc groups for most symptoms did not reveal significant differences. For heartburn, subjects using the discs perceived significantly less pain than subjects using the gel. We conclude that the use of certain products intended to reduce dry mouth during sleep, including OraCoat XyliMelts, may be an effective adjunctive remedy for reducing reflux and heartburn symptoms in patients with GERD and xerostomia.

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Modulation of salivation and heartburn in response to the site of acid infusion in the human oesophagus

Cited by 8 publications

References 15 publications

Gastroesophageal Reflux Disease and Tooth Erosion

Gastroesophageal Reflux Disease and Tooth Erosion

Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults

Effect on Acid Reflux Symptoms Occurring during Sleep of an Oral Adhering Disc Containing only Food Ingredients

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