{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T23:40:12Z","timestamp":1785195612055,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T00:00:00Z","timestamp":1611100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Following acid perfusion, esophageal pH is restored by swallowed bicarbonate\u2010containing saliva secreted in response to a vagal esophago\u2010salivary reflex. At impedance\u2010pH monitoring, the post\u2010reflux swallow\u2010induced peristaltic wave (PSPW) index puts into relationship timely post\u2010reflux swallows with the number of reflux events: Low values typify reflux\u2010related heartburn (RRH) and lack of on\u2010therapy improvement characterizes proton pump inhibitor (PPI) failure. Considerable esophageal pH increments associated with PSPWs could demonstrate the occurrence of esophago\u2010salivary reflex in clinical setting, while its relevance could be shown by lower esophageal pH increments in PPI\u2010refractory RRH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prospective multicenter study in patients with PPI\u2010refractory or PPI\u2010responsive RRH evaluated with off\u2010PPI impedance\u2010pH monitoring. Increments in pH associated with PSPWs were measured and the mean calculated to obtain the PSPW\u2010associated \u2206pH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>The mean PSPW\u2010associated \u2206pH in 294 RRH patients was 1.2\u00a0\u00b1\u00a00.7 and was lower in 137 PPI\u2010refractory (1.0\u00a0\u00b1\u00a00.6) than in 157 PPI\u2010responsive (1.5\u00a0\u00b1\u00a00.6) cases (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). Lower PSPW\u2010associated \u2206pH was independently related to PPI failure at multivariable logistic regression analysis (OR 0.16, 95% CI 0.09\u20130.26). At ROC analysis, comparing PPI\u2010refractory to PPI\u2010responsive cases the AUC for PSPW\u2010associated \u2206pH was 0.76 (95% CI 0.71\u20130.82), the best cutoff value being 1.2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>Considerable PSPW\u2010associated pH increments demonstrate the occurrence of esophago\u2010salivary reflex in clinical setting. Lower increments in PPI\u2010refractory RRH cases show the clinical relevance of esophago\u2010salivary reflex, confirming that PSPW represents a defense mechanism against reflux. PSPW\u2010associated \u2206pH can efficiently predict PPI response in patients undergoing off\u2010therapy impedance\u2010pH monitoring.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14085","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T14:57:49Z","timestamp":1611154669000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Esophageal pH increments associated with post\u2010reflux swallow\u2010induced peristaltic waves show the occurrence and relevance of esophago\u2010salivary reflex in clinical setting"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8608-1563","authenticated-orcid":false,"given":"Marzio","family":"Frazzoni","sequence":"first","affiliation":[{"name":"Digestive Pathophysiology Unit and Digestive Endoscopy Unit Baggiovara Hospital Modena 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