 |
|
|
|
|
|
|
|
|
|
|
|
 |
 |
 |
 |
 |
|
 |
SALIVARY GLANDS - SALIVA and GASTROESOPHAGEAL REFLUX
The many causes of sialorrhea seen in the Salivary Gland Center (SGC) include a wide variety of medications, some forms of epilepsy and affective disorders, and local irritating factors such as teething or dentures. Often the complaint is perceptual (somatoform) in origin.
A not uncommon cause of hypersalivation, albeit episodic, is gastroesophageal
reflux (GER). Reflux of GER is commonly associated with pregnancy and hiatal hernia (HH). In pregnancy, an increase in the circulating progesterone and estrogen seems to decrease LES contractility. The exact mechanism favoring GER in HH is not fully understood, but anatomic changes may impair the mechanisms of acid clearance and/or LES function. The SGC has examined many patients with episodic hypersalivation and heartburn. The precipitating factor for their visit, water brash, occurs when heartburn activates the ESR. A complaint of nocturnal drooling also develops when the supine position facilitates retrograde movement of stomach contents.
Water brash can be ameliorated by treating the GER, thus inhibiting excitation of the ESR. Metoclopramide will initiate smooth muscle contraction and will increase peristalsis and LES pressure. Cimetidine will reduce gastric acid production. GavisconÌs coating properties protect the esophagus from acid irritation. Other antacids, avoidance of alcohol, chocolate, fatty and spicy foods and large meals, and the elevation of the head during sleep are additional successful approaches. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
|
gastric
contents leads to esophageal irritation and the subjective symptoms
of heartburn, manifested by a midline retrosternal burning sensation.
Interference with the function of the lower esophageal sphincter
(LES), which normally guards against retrograde movement of gastric
acids, is a major factor. Once reflux occurs, esophageal peristalsis
may not be sufficient to rapidly clear the gastric acid. Effective
acid clearance seems to result largely from an esophagosalivary
reflex (ESR) mediated thru vagal afferents. Stimulation of the ESR
is the cause of the observed episodic sialorrhea (water brash).
With the inevitable swallow, the salivary hypersecretion with its
bicarbonate buffering system serves to neutralize residual gastric
acids and simultaneously lavages the esophageal wall. Progression
to GER disease, from chronic esophageal exposure to the contents
of gastric reflux, is discouraged.