Premium
Oesophageal sensation in response to high PCO 2 and acidic solutions in nonerosive reflux disease
Author(s) -
Hershcovici Tiberiu,
Poh Choo H.,
Fass Ofer Z.,
Ashpole Nicole,
Akiba Yasutada,
GuillénRodríguez Jose M.,
Kaunitz Jonathan D.,
Fass Ronnie
Publication year - 2012
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02560.x
Subject(s) - nerd , heartburn , reflux , gastroenterology , medicine , perfusion , gerd , disease
Eur J Clin Invest 2011 Abstract Background Heartburn is commonly associated with the presence of acid in the oesophageal lumen. However, in patients with nonerosive reflux disease (NERD), the mechanism by which acid traverses the mucosa is not clear. We hypothesized that the luminal acid signal traverses the oesophageal epithelium in the form of the highly permeant gas CO 2 , which then is reconverted to H + in the submucosa. Materials and methods Ten patients with heartburn, normal upper endoscopy and increased oesophageal acid exposure (NERD patients) and 10 healthy subjects were enrolled. Perceptual responses to intraoesophageal acid (0·1 N HCl solution) and a high PCO 2 solution were determined using a randomized cross over design. Stimulus–response functions to perfusions were quantified by three parameters: lag time to symptom perception, intensity rating and perfusion sensitivity score. Results In NERD patients, the difference in lag time to typical symptom perception, intensity rating and perfusion sensitivity score between high PCO 2 and acid perfusions was statistically significant ( P = 0·02, 0·01 and 0·02, respectively). However, the difference in the same perfusion parameters between acid and high PCO 2 perfusions was nonsignificant in healthy controls. When NERD and controls were compared, the difference between the different perfusion variables was nonsignificant (adjusted to age). Conclusions In NERD subjects, acid perfusion reliably evoked heartburn symptoms of greater intensity than in healthy controls. Nevertheless, a high PCO 2 perfusion failed to produce symptoms in either group.