{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T16:00:43Z","timestamp":1765641643378,"version":"3.48.0"},"reference-count":21,"publisher":"BMJ","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1993,11]]},"abstract":"<jats:p>This study examined the hypothesis that impaired oesophageal peristalsis was associated with delayed oesophageal clearance of acid in patients with progressive systemic sclerosis (PSS), some of whom are thought to have impaired oesophageal sensitivity to acid. Sixteen patients with PSS had: (a) oesophageal manometry and endoscopy; (b) acid perfusion of the oesophagus with simultaneous measurement of intraoesophageal pH during perfusion and for the next 10 minutes; (c) 22 hour monitoring of intraoesophageal pH; and (d) an evaluation of reflux symptoms during and after perfusion and during overnight pH monitoring. By oesophageal manometry, eight patients had normal peristalsis and eight patients had impaired peristalsis. Oesophageal endoscopy was unremarkable in patients with normal peristalsis, whereas all patients with impaired peristalsis had oesophagitis. The time needed to clear the oesophagus of perfused acid was shorter (p &lt; 0.01) in patients with normal peristalsis and acid clearance time was significantly correlated (p &lt; 0.01) with acid exposure time during overnight pH monitoring. During and after oesophageal perfusion, the nature, duration, and severity of symptoms did not differ between the groups, but overnight symptoms lasted longer (p &lt; 0.05) in patients with impaired peristalsis. It is concluded that in PSS: (1) Impaired oesophageal motility delayed the clearance of acid and increased the exposure time to acid. (2) Acid clearance time is a useful parameter of impaired oesophageal motor function. The assessment of acid clearance time can be used as an alternative to overnight pH monitoring, to assess the impairment of oesophageal acid clearance. (3) Oesophageal sensitivity to acid was preserved in patients with impaired peristalsis and oesophagitis. (4) Reflux symptoms lasted longer in patients with prolonged oesophageal acid exposure but were still reported for a small fraction of the total acid exposure time. Thus, reflux symptoms reflect poorly prolonged exposure of the oesophagus to acid and are not a reliable guide to acid injury of the oesophagus in PSS.<\/jats:p>","DOI":"10.1136\/gut.34.11.1487","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"1487-1491","source":"Crossref","is-referenced-by-count":19,"title":["Acid clearance and oesophageal sensitivity in patients with progressive systemic sclerosis."],"prefix":"10.1136","volume":"34","author":[{"given":"G","family":"Basilisco","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Barbera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Molgora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Vanoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Bianchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,11,1]]},"reference":[{"key":"ref_1","first-page":"92","article-title":"Esophageal deterioration","volume-title":"scleroderma. Mayo Clin Proc 1971","volume":"46","author":"Garrett, J.M.; Winkelmann, R.K.; Schlegel, J.F.; Code, C.F.","unstructured":"Garrett JM, Winkelmann RK, Schlegel JF, Code CF. Esophageal deterioration in scleroderma. Mayo Clin Proc 1971; 46: 92-6."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/0016-5085(87)90137-5","article-title":"Esophagitis in scleroderma. Prevalence and risk factors","volume":"92","author":"Zamost, B.J.; Hirschberg, J.; Ippoliti, A.F.; Furst, D.E.; Clements, P.J.; Weinstein, W.M.","year":"1987","unstructured":"Zamost BJ, Hirschberg J, Ippoliti AF, Furst DE, Clements PJ, Weinstein WM. Esophagitis in scleroderma. Prevalence and risk factors. Gastroenterology 1987; 92: 421-8.","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/0016-5085(92)91713-E","article-title":"Comparative studies of esophageal function in systemic sclerosis","volume":"102","author":"Klein, H.A.; Wald, A.; Graham, T.O.; Campbell, W.L.; Steen, V.D.","year":"1992","unstructured":"Klein HA, Wald A, Graham TO, Campbell WL, Steen VD. Comparative studies of esophageal function in systemic sclerosis. Gastroenterology 1992; 102: 1551-6.","journal-title":"Gastroenterology"},{"key":"ref_4","first-page":"833","article-title":"Prolonged clearance is the primary abnormal reflux parameter in patients with progressive systemic sclerosis and esophagitis","volume":"37","author":"Murphy, JR, McNally; P, Peller; P, Shay; S.S.","year":"1992","unstructured":"Murphy JR, McNally P, Peller P, Shay SS. Prolonged clearance is the primary abnormal reflux parameter in patients with progressive systemic sclerosis and esophagitis. DigDisSci 1992; 37: 833-41.","journal-title":"DigDisSci"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/0016-5085(84)90089-1","article-title":"Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis","volume":"87","author":"Maddern, G.J.; Horowitz, M.; Jamieson, G.G.; Chatterton, B.E.; Collins, P.J.; Roberts-Thomson, P.","year":"1984","unstructured":"Maddern GJ, Horowitz M, Jamieson GG, Chatterton BE, Collins PJ, Roberts-Thomson P. Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis. Gastroenterology 1984; 87: 922-6.","journal-title":"Gastroenterology"},{"key":"ref_6","first-page":"376","volume-title":"Pathogenesis of reflux esophagitis. Gastroenterology 1981; 81","author":"Dodds, W.J.; Hogan, W.J.; Helm, J.F.; Dent, J.","unstructured":"Dodds WJ, Hogan WJ, Helm JF, Dent J. Pathogenesis of reflux esophagitis. Gastroenterology 1981; 81: 376-94."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/S0003-4975(10)63972-0","article-title":"Gastroesophageal reflux in esophageal scieroderma: diagnosis and implications","volume":"22","author":"Orringer, M.B.; Dabich, L.; Zarafonetis, C.J.D.; Sloan, H.","year":"1976","unstructured":"Orringer MB, Dabich L, Zarafonetis CJD, Sloan H. Gastroesophageal reflux in esophageal scieroderma: diagnosis and implications. Ann Thorac Surg 1976; 22: 120-30.","journal-title":"Ann Thorac Surg"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1001\/archneur.1970.00480200032003","article-title":"Neurologic manifestations in progressive systemic sclerosis","volume":"22","author":"Gordon, R.M.; Silverstein, A.","year":"1970","unstructured":"Gordon RM, Silverstein A. Neurologic manifestations in progressive systemic sclerosis. Arch Neurol 1970; 22: 126-34.","journal-title":"Arch Neurol"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/BF00685970","article-title":"Peripheral neuropathy in course of progressive systemic sclerosis","volume":"72","author":"G, Di Trapani; A, Tulli; A, La Cara; P, Laurienzo; S, Mazza; P, David","year":"1986","unstructured":"Di Trapani G, Tulli A, La Cara A, Laurienzo P, Mazza S, David P. Peripheral neuropathy in course of progressive systemic sclerosis. Acta Neuropathol (Berl) 1986; 72: 103-10.","journal-title":"Acta Neuropathol (Berl)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1136\/ard.45.11.957","article-title":"Autonomic neuropathy in systemic sclerosis: a case report and evaluation of six patients","volume":"45","author":"Sonnex, C.; Paice, E.; White, A.G.","year":"1986","unstructured":"Sonnex C, Paice E, White AG. Autonomic neuropathy in systemic sclerosis: a case report and evaluation of six patients. Ann Rheum Dis 1986; 45: 957-60.","journal-title":"Ann Rheum Dis"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1136\/ard.47.7.542","article-title":"Autonomic neuropathy in systemic sclerosis","volume":"47","author":"Klimiuk, P.S.; Taylor, L.; Baker, R.D.; Jayson, M.I.V.","year":"1988","unstructured":"Klimiuk PS, Taylor L, Baker RD, Jayson MIV. Autonomic neuropathy in systemic sclerosis. Ann Rheum Dis 1988; 47: 542-5.","journal-title":"Ann Rheum Dis"},{"key":"ref_12","first-page":"91","article-title":"Neurological complications of systemic sclerosis - a report of three cases and review of the literature. Clin Exp Dermatol","volume":"15","author":"Berth-Jones, J.; Coates, P.A.A.; Graham-Brown, R.A.C.; Burns, D.A.","year":"1990","unstructured":"Berth-Jones J, Coates PAA, Graham-Brown RAC, Burns DA. Neurological complications of systemic sclerosis - a report of three cases and review of the literature. Clin Exp Dermatol 1990; 15: 91-4."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1172\/JCI107084","article-title":"The pathogenesis of esophageal dysfunction in scleroderma and Raynaud's disease","volume":"51","author":"Cohen, S.; Fisher, R.; Lipshutz, W.; Turner, R.; Myers, A.; Schumacher, R.","year":"1972","unstructured":"Cohen S, Fisher R, Lipshutz W, Turner R, Myers A, Schumacher R. The pathogenesis of esophageal dysfunction in scleroderma and Raynaud's disease. J Clin Invest 1972; 51: 2663-8.","journal-title":"J Clin Invest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1002\/art.1780230510","article-title":"Preliminary criteria for the classification of systemic sclerosis (scleroderma)","volume":"23","author":"Masi, A.T.","year":"1980","unstructured":"Masi AT. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980; 23: 581-9.","journal-title":"Arthritis Rheum"},{"key":"ref_15","first-page":"583","article-title":"Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of 'abnormal' contractions","volume":"32","author":"Richter, J.E.; Wu, W.C.; Johns, D.N.; Blackwell, J.N.; Nelson, J.L.; Castell, J.A.","year":"1987","unstructured":"Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of 'abnormal' contractions. DigDisSci 1987; 32: 583-92.","journal-title":"DigDisSci"},{"key":"ref_16","first-page":"358","article-title":"The symptoms index: A clinically important parameter of ambulatory 24-hour esophageal pH monitoring","volume":"83","author":"Wiener, G.J.; Richter, J.E.; Copper, J.B.; Wu, W.C.; Castell, D.O.","year":"1988","unstructured":"Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO. The symptoms index: A clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol 1988; 83: 358-61.","journal-title":"Am J Gastroenterol"},{"key":"ref_17","first-page":"607","article-title":"Determinants ofesophageal acid clearance","volume-title":"normal subjects. Gastroenterology 1983; 85","author":"Helm, J.F.; Dodds, W.J.; Riedel, D.R.; Teeter, B.C.; Hogan, W.J.; Arndorfer, R.C.","unstructured":"Helm JF, Dodds WJ, Riedel DR, Teeter BC, Hogan WJ, Arndorfer RC. Determinants ofesophageal acid clearance in normal subjects. Gastroenterology 1983; 85: 607-12."},{"issue":"94","key":"ref_18","first-page":"73","article-title":"Effect of peristaltic dysfunction on esophageal volume clearance","volume":"1988","author":"Kahrilas, P.J.; Dodds, W.J.; Hogan, W.J.","unstructured":"Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 1988; 94: 73-80.","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1136\/gut.30.11.1523","article-title":"Heartburn - the acid test","volume":"30","author":"Joelsson, B.; Johnsson, F.","year":"1989","unstructured":"Joelsson B, Johnsson F. Heartburn - the acid test. Gut 1989; 30: 1523-5.","journal-title":"Gut"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/0016-5085(90)91147-X","article-title":"Analysis of24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain","volume":"99","author":"Breumelhof, R.; Nadorp, J.H.S.M.; Akkermans, L.M.A.; Smout, A.J.P.M.","year":"1990","unstructured":"Breumelhof R, Nadorp JHSM, Akkermans LMA, Smout AJPM. Analysis of24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain. Gastroenterology 1990; 99: 1257-64.","journal-title":"Gastroenterology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1007\/BF01536707","article-title":"Acid gastroesophageal reflux and symptom occurrence. Analysis of some factors influencing their association","volume":"34","author":"Baldi, F.; Ferrarini, F.; Longanesi, A.; Ragazzini, M.; Barbara, L.","year":"1989","unstructured":"Baldi F, Ferrarini F, Longanesi A, Ragazzini M, Barbara L. Acid gastroesophageal reflux and symptom occurrence. Analysis of some factors influencing their association. Dig Dis Sci 1989; 34: 1890-3.","journal-title":"Dig Dis Sci"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.34.11.1487","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T15:57:01Z","timestamp":1765641421000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.34.11.1487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,11]]},"references-count":21,"journal-issue":{"issue":"11","published-online":{"date-parts":[[1993,11,1]]},"published-print":{"date-parts":[[1993,11]]}},"alternative-id":["10.1136\/gut.34.11.1487"],"URL":"https:\/\/doi.org\/10.1136\/gut.34.11.1487","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"type":"print","value":"0017-5749"},{"type":"electronic","value":"1468-3288"}],"subject":[],"published":{"date-parts":[[1993,11]]}}}