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Esophageal Clearance in Gastroesophageal Reflux

  • Maheen Hassan
  • Frederick W. Woodley
  • Hayat Mousa
Chapter

Abstract

Gastroesophageal reflux is a normal physiologic process, with multiple mechanisms in place to prevent physiologic reflux from becoming pathologic. One such mechanism is esophageal clearance. Esophageal clearance is composed of two distinct phases: volume clearance and chemical clearance. Volume clearance utilizes swallowing and esophageal peristalsis to empty the esophagus of reflux bolus and virtually all acid. Chemical clearance neutralizes the residual acid film by saliva, either swallowed or secreted by the esophagus. Combined pH-multichannel intraluminal impedance is the best technique to measure both phases of clearance. Normal values for children have been established. If either phase of esophageal clearance is prolonged, the esophagus experiences increased acid exposure, and this can result in secondary complications. There are physiologic and disease states which can impact either or both of the clearance phases. They do so by impacting the swallow, esophageal peristalsis, esophageal motility, and composition or quantity of saliva. As a result, these patients are predisposed to gastroesophageal reflux disease.

Keywords

Gastroesophageal reflux Acid reflux Esophageal clearance Volume clearance Bolus transit Chemical clearance Impedance Normal values Sleep Body position Pathophysiology Pediatrics 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Maheen Hassan
    • 1
  • Frederick W. Woodley
    • 2
    • 3
  • Hayat Mousa
    • 1
  1. 1.Department of Pediatric GastroenterologyUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of Pediatric GastroenterologyNationwide Children’s HospitalColumbusUSA
  3. 3.Department of PediatricsThe Ohio State University College of MedicineColumbusUSA

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