Abstract
Recent studies indicate that swallow-induced, primary peristalsis is a major determinant of normal esophageal acid clearance. However, factors that regulate the rate of spontaneous swallowing in normal subjects are incompletely understood. We postulated that the rate of salivary flow influences the rate of spontaneous swallows. To test this hypothesis, we did a total of 60 studies measuring salivary flow or the rate of spontaneous swallowing in 10 healthy volunteers, age 10–30 years. Saliva was collected by expectoration. Swallow rate was recorded by a small, transnasal catheter stationed in the pharynx and also, in some circumstances, by cervical electrodes. On separate sessions, we evaluated the effect of five test manipulations on salivary flow and swallowing rate, respectively. The test manipulations consisted of: (1) pharyngeal intubation, (2) sucking of a dummy lozenge, (3) sucking of a peppermint lozenge, (4) bethanechol injection (5 mg subcutaneously), and atropine administration (12 μg/kg intravenously). Pharyngeal intubation caused a small, but significant increase in the rate of salivation and spontaneous swallows. Sucking of a peppermint lozenge caused a sixfold increase in salivary flow while nearly doubling the swallowing rate whereas the dummy lozenge caused only a modest increase in salivary flow and swallowing. Cholinergic stimulation by bethanechol elicited a substantial increase in salivary flow and swallowing rate. In contrast, atropine caused a significant decrease in both salivary flow and swallowing. We conclude that in awake, normal subjects the rate of spontaneous swallows is influenced directly by salivary flow. Because oral lozenges substantially increase both swallowing rate and salivary flow, such agents merit investigation as a potentially useful ancillary treatment for the relief of heartburn.
Similar content being viewed by others
References
Helm JF, Dodds WJ, Hogan WJ, Soergel KH, Egide MS, Wood CM: Acid neutralizing capacity of human saliva. Gastroenterology 83:69–74, 1982
Helm JF, Dodds WJ, Riedel DR, Teeter BC, Hogan WJ, Arndorfer RC: Determinants of esophageal acid clearance in normal subjects. Gastroenterology 85:607–612, 1983
Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ: Mechanisms of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980
Lichter I, Muir RC: The pattern of swallowing during sleep. Electroencephalogr Clin Neurophysiol 38:427–432, 1975
Dodds WJ, Hogan WJ, Lydon SB, Stewart ET, Stef JJ, Arndorfer RC: Quantitation of pharyngeal motor function in normal human subjects. J Appl Physiol 39:692–696, 1975
Dodds WJ: Instrumentation and methodology for intraluminal esophageal manometry. Arch Intern Med 136:515–523, 1976
Lear CSC, Flanagan JB Jr, Moorrees CFA: The frequency of deglutition in man. Arch Oral Biol 10:83–99, 1965
Orr WC, Robinson MG, Johnson LF: Acid clearance during sleep in the pathogenesis of reflex esophagitis. Dig Dis Sci 26:423–427, 1981
Becks H, Wainwright WW: Human saliva. XIII. Rate of flow of resting saliva of healthy individuals. J Dent Res 22:391–396, 1943
Spealman CR. The volume flow of resting salivary secretions. Am J Physiol 139:225–229, 1943
Schneyer LH: Source of resting total mixed saliva of man. J Appl Physiol 9:79–81, 1956
Dodds WJ, Hogan WJ, Reid DP, Stewart ET, Arndorfer RC: A comparison between primary esophageal peristalsis following wet and dry swallows. J Appl Physiol 35:851–857, 1973
Schneyer LH, Pigman W, Hanahan L, Gilmore RW: Rate of flow of human parotid, sublingual, and submaxillary secretions during sleep. J Dent Res 35:109–114, 1956
Booth DJ, Kemmerer WT, Skinner DB: Acid clearing from the distal esophagus. Arch Surg 96:731–734, 1968
Stanciu C, Bennett JR: Oesophageal acid clearing: One factor in the production of reflux oesophagitis. Gut 15:852–857, 1974
Dodds WJ, Hogan WJ, Helm JF, Dent J: Pathogenesis of reflux esophagitis. Gastroenterology 81:376–394, 1981
Helm JF, Dodds WJ, Pelc LR, Palmer DW, Hogan WJ, Teeter BC: Mechanisms of esophageal acid clearance in supine normal subjects. A unifying hypothesis. Gastroenterology 80:1171, 1981 (abstract)
Farrell RL, Roling GT, Castell DO: Cholinergic therapy of chronic heartburn. A controlled trial. Ann Intern Med 80:573–576, 1974
Thanik KD, Chey WY, Shah AN, Gutierrez JG: Reflux esophagitis: Effect of oral bethanechol on symptoms and endoscopic findings. Ann Intern Med 93:805–808, 1980
Humphries TJ, Castell DO: Effect of oral bethanechol on parameters of esophageal peristalsis. Dig Dis Sci 26:129–132, 1981
Miller WN, Ganeshappa KP, Dodds WJ, Hogan WJ, Barreras RF, Arndorfer RC: Effect of bethanechol on gastroesophageal reflux. Am J Dig Dis 22:230–234, 1977
Author information
Authors and Affiliations
Additional information
This work was supported, in part, by National Institutes of Health grants AM 15540 and Am 25731, and by a grant from the Clinical Research Center's program No. 0005A.
Rights and permissions
About this article
Cite this article
Kapila, Y.V., Dodds, W.J., Helm, J.F. et al. Relationship between swallow rate and salivary flow. Digest Dis Sci 29, 528–533 (1984). https://doi.org/10.1007/BF01296273
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296273