Esophageal Emptying and Acid Neutralization in Patients with Symptoms of Esophageal Reflux

Abstract

Clearance of refluxed acid from the distal esophagus is due to bolus emptying and salivary neutralization of acid. The results of 24-h pH monitoring with acid clearance tests (ACT) and radioisotope swallows (RIS) were compared in 26 symptomatic patients to determine which of the components of acid clearance were better correlated with gastroesophageal acid reflux (GER). Seven of 8 patients with GER had delayed esophageal emptying on RIS. Abnormal salivary clearance of acid was present in 9 of 18 patients without GER, accounting for a high false-positive rate of ACT. Delayed esophageal bolus emptying, not deficient acid neutralization by saliva, was the predominant component of abnormal acid clearance in patients with GER. RIS was superior to ACT as part of the evaluation of reflux symptoms, and may prove to be a valuable screening test for this condition.