Effect of Autonomic Modulation on Human Esophageal Pain Hypersensitivity

Botha, Claude; Naqvi, Hira; Chua, Ying Xian; Knowles, Charles H.; Aziz, Qasim

doi:10.1016/s0016-5085(11)60664-1

Cited by 4 publications

(4 citation statements)

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“…This is a subjective measure, resulting in individualized stimulation intensities, and is consistent with all previous literature establishing visceral EPs in humans as an investigative technique 15,17,20,24,26,34,35,42,53 . Nevertheless, it is appreciated that such an approach relies on the assumption that two individuals experience the same quality of sensation (although at different stimulation intensities), and it is known that visceral sensation is, of course, affected by mood, stress levels etc 54–58 . However, standardizing an optimal stimulation intensity was not possible, as the mean pain threshold in patients was greater than that of the maximal tolerable sensation of healthy volunteers.…”

Section: Discussionsupporting

confidence: 75%

“…15,17,20,24,26,34,35,42,53 Nevertheless, it is appreciated that such an approach relies on the assumption that two individuals experience the same quality of sensation (although at different stimulation intensities), and it is known that visceral sensation is, of course, affected by mood, stress levels etc. [54][55][56][57][58] However, standardizing an optimal stimulation intensity was not possible, as the mean pain threshold in patients was greater than that of the maximal tolerable sensation of healthy volunteers. Conversely, the intensity required to stimulate pain in our healthy subjects would have been subsensory in almost 50% of the patients with RH.…”

Section: Methodological Aspectsmentioning

confidence: 99%

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Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity

Burgell

Lelic

Carrington

et al. 2012

Neurogastroenterology Motil

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Section: Discussionsupporting

confidence: 75%

Section: Methodological Aspectsmentioning

confidence: 99%

Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity

Burgell

Lelic

Carrington

et al. 2012

Neurogastroenterology Motil

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“…GERD is frequently associated with hypersensitivity (15). Physical activity enhances the parasympathetic autonomic system (17), and this is associated with a reduction in hypersensitivity (3).…”

Section: Discussionmentioning

confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Nobre e Souza MÂ, Lima MJ, Martins GB, Nobre RA, Souza MH, de Oliveira RB, dos Santos AA. Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol 305: G862-G867, 2013. First published October 10, 2013 doi:10.1152/ajpgi.00054.2013.-The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20 -47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20 -41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 Ϯ 2.4 vs. 29.5 Ϯ 2.1 mmHg; P Ͻ 0.001) and inspiratory EGJ pressure during SAM (89.6 Ϯ 7.6 vs. 125.6 Ϯ 13.3 mmHg; P ϭ 0.001) and during TH maneuvers. The EGJ-pressure gain across 35-and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment. crural diaphragm; GERD; lower esophageal sphincter; muscle training

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“… 57 This suggests any potential abnormality may be above the level of the reflex arc. Furthermore, early evidence (from studies of esophageal pain and in patients with IBS) suggests that visceral sensory function may also be influenced by personality profile, autonomic nervous system function and psychological phenotype; 58 - 62 however this has yet to be examined directly in patients with rectal hyposensitivity.…”

Section: Pathophysiologymentioning

confidence: 99%

Rectal Hyposensitivity

Burgell¹,

Scott²

2012

J Neurogastroenterol Motil

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Impaired or blunted rectal sensation, termed rectal hyposensitivity (RH), which is defined clinically as elevated sensory thresholds to rectal balloon distension, is associated with disorders of hindgut function, characterised primarily by symptoms of constipation and fecal incontinence. However, its role in symptom generation and the pathogenetic mechanisms underlying the sensory dysfunction remain incompletely understood, although there is evidence that RH may be due to 'primary' disruption of the afferent pathway, 'secondary' to abnormal rectal biomechanics, or to both. Nevertheless, correction of RH by various interventions (behavioural, neuromodulation, surgical) is associated with, and may be responsible for, symptomatic improvement. This review provides a contemporary overview of RH, focusing on diagnosis, clinical associations, pathophysiology, and treatment paradigms.

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Effect of Autonomic Modulation on Human Esophageal Pain Hypersensitivity

Cited by 4 publications

References 0 publications

Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity

Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity

Inspiratory muscle training improves antireflux barrier in GERD patients

Rectal Hyposensitivity

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