Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1985 Jun;201(6):728–735. doi: 10.1097/00000658-198506000-00009

Esophageal emptying and acid neutralization in patients with symptoms of esophageal reflux.

M K Ferguson, J W Ryan, A G Little, D B Skinner
PMCID: PMC1250805  PMID: 4004384

Abstract

Clearance of refluxed acid from the distal esophagus is due to bolus emptying and salivary neutralization of acid. We compared results of 24-hour pH monitoring with acid clearance tests (ACT) and radioisotope swallows (RIS) in 26 symptomatic patients to determine which of the components of acid clearance is better correlated with gastroesophageal acid reflux (GER). Seven of eight patients with GER had delayed esophageal emptying on RIS. Abnormal salivary clearance of acid was present in nine of 18 patients without GER, accounting for a high false-positive rate of ACT. Delayed esophageal bolus emptying, not deficient acid neutralization by saliva, is the predominant component of abnormal acid clearance in patients with GER. RIS is superior to ACT as part of the evaluation of reflux symptoms, and may prove to be a valuable screening test for this condition.

Full text

PDF
729

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benjamin S. B., O'Donnell J. K., Hancock J., Nielsen P., Castell D. O. Prolonged radionuclide transit in "nutcracker esophagus". Dig Dis Sci. 1983 Sep;28(9):775–779. doi: 10.1007/BF01296898. [DOI] [PubMed] [Google Scholar]
  2. Blackwell J. N., Hannan W. J., Adam R. D., Heading R. C. Radionuclide transit studies in the detection of oesophageal dysmotility. Gut. 1983 May;24(5):421–426. doi: 10.1136/gut.24.5.421. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Booth D. J., Kemmerer W. T., Skinner D. B. Acid clearing from the distal esophagus. Arch Surg. 1968 May;96(5):731–734. doi: 10.1001/archsurg.1968.01330230039006. [DOI] [PubMed] [Google Scholar]
  4. Helm J. F., Dodds W. J., Hogan W. J., Soergel K. H., Egide M. S., Wood C. M. Acid neutralizing capacity of human saliva. Gastroenterology. 1982 Jul;83(1 Pt 1):69–74. [PubMed] [Google Scholar]
  5. Helm J. F., Dodds W. J., Pelc L. R., Palmer D. W., Hogan W. J., Teeter B. C. Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med. 1984 Feb 2;310(5):284–288. doi: 10.1056/NEJM198402023100503. [DOI] [PubMed] [Google Scholar]
  6. Helm J. F., Dodds W. J., Riedel D. R., Teeter B. C., Hogan W. J., Arndorfer R. C. Determinants of esophageal acid clearance in normal subjects. Gastroenterology. 1983 Sep;85(3):607–612. [PubMed] [Google Scholar]
  7. Holloway R. H., Krosin G., Lange R. C., Baue A. E., McCallum R. W. Radionuclide esophageal emptying of a solid meal to quantitate results of therapy in achalasia. Gastroenterology. 1983 Apr;84(4):771–776. [PubMed] [Google Scholar]
  8. Joelsson B. E., DeMeester T. R., Skinner D. B., LaFontaine E., Waters P. F., O'Sullivan G. C. The role of the esophageal body in the antireflux mechanism. Surgery. 1982 Aug;92(2):417–424. [PubMed] [Google Scholar]
  9. Kazem I. A new scintigraphic technique for the study of the esophagus. Am J Roentgenol Radium Ther Nucl Med. 1972 Aug;115(4):681–688. doi: 10.2214/ajr.115.4.681. [DOI] [PubMed] [Google Scholar]
  10. O'Sullivan G. C., DeMeester T. R., Joelsson B. E., Smith R. B., Blough R. R., Johnson L. F., Skinner D. B. Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence. Am J Surg. 1982 Jan;143(1):40–47. doi: 10.1016/0002-9610(82)90127-1. [DOI] [PubMed] [Google Scholar]
  11. Russell C. O., Gannan R., Coatsworth J., Neilsen R., Allen F., Hill L. D., Pope C. E., 2nd Relationship among esophageal dysfunction, diabetic gastroenteropathy, and peripheral neuropathy. Dig Dis Sci. 1983 Apr;28(4):289–293. doi: 10.1007/BF01324943. [DOI] [PubMed] [Google Scholar]
  12. Russell C. O., Hill L. D., Holmes E. R., 3rd, Hull D. A., Gannon R., Pope C. E., 2nd Radionuclide transit: a sensitive screening test for esophageal dysfunction. Gastroenterology. 1981 May;80(5 Pt 1):887–892. [PubMed] [Google Scholar]
  13. Russell C. O., Pope C. E., 2nd, Gannan R. M., Allen F. D., Velasco N., Hill L. D. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux. Ann Surg. 1981 Sep;194(3):290–296. doi: 10.1097/00000658-198109000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Skinner D. B., Booth D. J. Assessment of distal esophageal function in patients with hiatal hernia and-or gastroesophageal reflux. Ann Surg. 1970 Oct;172(4):627–637. doi: 10.1097/00000658-197010000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Skinner D. B., Demeester T. R. Gastroesophageal reflux. Curr Probl Surg. 1976 Jan;13(1):1–62. doi: 10.1016/s0011-3840(76)80012-3. [DOI] [PubMed] [Google Scholar]
  16. Tolin R. D., Malmud L. S., Reilley J., Fisher R. S. Esophageal scintigraphy to quantitate esophageal transit (quantitation of esophageal transit). Gastroenterology. 1979 Jun;76(6):1402–1408. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES