Oesophageal acid clearing: one factor in the production of reflux oesophagitis

Abstract

Esophageal acid clearing was measured by counting the number of swallows needed to raise the lower esophageal pH from 1.5 to 5.0 after instilling 15 ml 0.1 N hydrochloric acid. Normal subjects all had a result less than 12, as did asymptomatic patients with hiatal hernias. Patients with symptomatic gastroesophageal reflux tended to have abnormal acid clearance, as did those esophageal motility disorders. Acid clearance correlated well with the mean duration of spontaneous episodes of acid reflux during 15 hr continuous recordings of lower esophageal pH. Abnormal acid clearance was improved by raising the bedhead, by medical treatment for esophagitis, and by metoclopramide. The authors conclude that abnormal acid clearing may result from disturbed esophageal motility and render patients with these disorders susceptible to reflux esophagitis. However, it also seems that gastroesophageal reflux may lead to impaired acid clearance, both by creating abnormal motility and by effects on the esophageal wall, and thus lead to a 'vicious spiral' esophagitis. In treating gastroesophageal reflux, attention must be paid to improving acid clearance. (12 references).