Reflux characteristics triggering post‐reflux swallow‐induced peristaltic wave (PSPW) in patients with GERD symptoms. Issue 2 (29th May 2021)

• Record Type: Journal Article
• Authors: Ribolsi, Mentore; Frazzoni, Marzio; De Bortoli, Nicola; Tolone, Salvatore; Arsiè, Elena; Mariani, Lucia; De Carlo, Giovanni; Maniero, Daria; Penagini, Roberto; Cicala, Michele; Savarino, Edoardo
• Is Part Of: Neurogastroenterology & motility. Volume 34:Issue 2(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-05-29
• Subjects: GERD -- PPI -- PSPW; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.14183
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Esophageal chemical clearance has been evaluated with the post‐reflux swallow‐induced peristaltic wave (PSPW) index. The factors triggering PSPW in Gastro‐esophageal reflux disease (GERD) have not yet been investigated. This multicenter study was aimed at evaluating the characteristics of reflux episodes associated with PSPW occurrence in patients with typical GERD symptoms. Methods: Impedance‐pH tracings from patients with typical reflux symptoms were analyzed. Sixteen healthy subjects were included for comparison. Multivariate analysis was performed to determine predictors of PSPW events. Key results: Impedance‐pH tracings from 60 patients and 16 healthy subjects were evaluated. A total of 3454 refluxes were recorded. In patients, comparing reflux episodes followed with those not followed by a PSPW, significantly higher proportions of acid (79% vs. 74%, p : 0.02), mixed (47% vs. 32%, p : 0.0001) and proximal refluxes (34% vs. 20%, p : 0.0001) were observed. A multivariate analysis, acid (OR: 1.3, 95% CI: 1.05–1.6), mixed (OR: 2, 95% CI: 1.6–2.3), and proximal (OR: 2.1, 95% CI: 1.7–2.5) refluxes were independently associated with PSPWs. Reflux episodes followed by a PSPW were characterized by a significantly higher bolus clearing time [(mean ± SD) 41 s ± 6 s vs. 30 s ± 5 s, p < 0.05] whereas nadir pH value of reflux events preceding PSPWs was tangentially but not significantly lower [(mean ± SD) 2.61 ± 1.22 vs. 2.74 ± 1.26, p : 0.057]. Conclusions and inferences: Acid, mixed and proximal refluxes, and their duration are key factors in eliciting PSPWs. PSPW represents a response to reflux directly related to the potential harmfulness of reflux contents. Abstract : PSPWs are more frequently elicited by acid, mixed, and proximal refluxes as well as by prolonged reflux events. PSPWs elicitation is directly related to the aggressive characteristics of refluxate.