What role do salivary inorganic components play in health and disease of the esophageal mucosa?

The integrity of the esophageal mucosa depends upon an equilibrium between aggressive factors and protective mechanisms. Esophageal mucosal protective mechanisms operate at three overlapping levels: (1) preepithelial, (2) epithelial and (3) postepithelial. Since aggressive factors always operate on the luminal side of the esophagus, preepithelial defense remains as the first line in mucosal barrier protection. Salivary secretion quantitatively and qualitatively contributes to the protective potential of the preepithelial barrier. Salivary volume and its buffering capacity are elaborated by lowering intraluminal pH within the esophagus, and are key factors in restoration of physiologic pH within the esophagus. Salivary secretory response to esophageal mechanical (bolus) and chemical (intraluminal pH) stimuli, mediated by the esophagosalivary reflex pathway, is impaired in patients with reflux esophagitis.