Neurophysiologic Assessment of Esophageal Sensory Processing in Noncardiac Chest Pain

Hobson, Anthony; Furlong, Paul L.; Sarkar, S; Matthews, Philip J; Willert, Robert P.; Worthen, Siân F.; Unsworth, Barbara J.; Aziz, Qasim

doi:10.1053/j.gastro.2005.10.016

Cited by 96 publications

(55 citation statements)

References 46 publications

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“…Several studies have examined the amplitudes and latencies of painful CEPs in the gut, and compared the results between a control group, and a study group (i.e. patients suffering from chronic pancreatitis, non-cardiac chest pain or patients treated with analgesics) [46][47][48][49][50][51] . Dimcevski et al [46] showed decreased early CEP latencies in patients with CP compared to healthy controls.…”

Section: Eegmentioning

confidence: 99%

“…Mayer et al [38] have recently reviewed imaging studies in FGID which has been critiqued by Hobson and Aziz [36,37,72] . "Visceral hypersensitivity" is a hallmark feature in IBS patients, who show an abnormal pattern of ACC activation during pain perception which is an interesting parallel to ACC activation relative to increasing pain perception in healthy subjects [43,73,74] ; hemispheric preference, as well as cognitive style of information processing served as indicators of covert changes in brain functions in 21 adult IBS patients [75] ; and abnormal cerebral processing of oesophageal stimuli was found in patients with noncardiac chest pain [50,51] . Drossman et al [76] found that alterations in brain activity were associated with resolution of emotional distress and pain in a case of severe IBS.…”

Section: Inverse Modelling Of Cortical Evoked Potentialsmentioning

confidence: 99%

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New technologies to investigate the brain-gut axis

Sharma¹,

Lelic²,

Brock³

et al. 2009

WJG

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Section: Eegmentioning

confidence: 99%

Section: Inverse Modelling Of Cortical Evoked Potentialsmentioning

confidence: 99%

New technologies to investigate the brain-gut axis

Sharma¹,

Lelic²,

Brock³

et al. 2009

WJG

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“…We have now begun to translate these fi ndings into a population of patients with NCCP and have indeed shown that a subset of these patients (approx. 35%) have neurophysiological profi les consistent with increases in central afferent pathway sensitivity [48] . However, just as importantly, we have identifi ed a second subset of NCCP patients that have identical clinical and psychophysical characteristics in association with esophageal hypersensitivity, but have distinctly different neurophysiological profi les.…”

Section: Afferent Pathway Sensitivitymentioning

confidence: 98%

“…It is possible that this group of patients have a predominantly psychological cause for their symptoms, a factor which would indicate a different treatment and management strategy to those with sensitized esophageal afferents [48] .…”

Section: Afferent Pathway Sensitivitymentioning

confidence: 99%

Assessment of Gastrointestinal Sensation – A Review

Hobson¹,

Aziz²

2006

Dig Dis

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Understanding the mechanisms of symptoms in patients with gastrointestinal disorders remains a great challenge. One of the major problems facing clinicians in this area is the limited information gained from subjective outcome measures commonly used to assess these conditions. To address this, various stimulation and recording techniques, commonly used by neurologists, have been adapted to study gastrointestinal sensory processing. This review article provides an overview of this expanding research area and discusses the advantages and disadvantages of each approach.

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“…Studies of brain activity during oesophageal stimulation have described discrete abnormalities of peripheral (visceral afferent), central (spinal) and psychological function in this patient population. 12 It may be possible in the future to use this information to direct individual treatment of neuropsychologic pathology in UCP.…”

Section: Oesophageal Sensitivitymentioning

confidence: 99%

Unexplained (non-cardiac) chest pain

Fox

Forgács

2006

Clinical Medicine

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Unexplained (non-cardiac) chest pain GastroenterologyEdited by Ian Forgacs MD FRCP, Consultant Gastroenterologist, King's College Hospital, London• Oesophageal (40-60%) Gastro-oesophageal reflux disease (acid and non-acid) Visceral hypersensitivity Oesophageal motor dysfunction ± bolus escape -Nutcracker oesophagus, oesophageal spasm, achalasia -Weak and/or ineffective peristalsis• Musculoskeletal (10-20%) Fibromyalgia, costochondritis, spinal problems• Psychological (20-60%)Panic attacks, anxiety, depression, somatisation, hypochondria • MiscellaneousPulmonary disease, breast conditions, herpes zoster Cardiac disease Gastrointestinal investigationsVarious gastrointestinal investigations are available (Table 2) but many lack diagnostic sensitivity in UCP whereas others are time-consuming and poorly tolerated. EndoscopyEndoscopy is usually normal, with reflux oesophagitis revealed in only 10-25%.There is a very low pick-up of more serious disease. Barium studiesBarium studies are even less likely to provide useful information unless dysphagia accompanies chest pain. Ambulatory monitoringThe single most useful investigation in UCP is ambulatory 24-hour pH measurement. It is not known why some patients complain of heartburn and others of chest pain in response to oesophageal acid, but 40-60% of patients with UCP have pathological levels of acid exposure diagnostic of gastrooesophageal reflux disease (GORD). Other patients complain of chest pain in association with isolated acid reflux events (indicative of visceral hypersensitivity). Some of these experience UCP only a few times a week and require prolonged pH monitoring to increase diagnostic sensitivity.The clinical impact of pH studies is that patients with a proven association between acid reflux events and UCP are significantly more likely to respond to acid suppression than those without such findings (Fig 1). 7,8 Multichannel intraluminal impedanceThe combination of multichannel intraluminal impedance and pH catheters detects both acid and non-acid reflux and follows bolus transport through the oesophagus. Overall in GORD, this technique improves the ability to associate symptoms and reflux events by 10-20%. 9 The ability to detect non-acid reflux may be particularly useful in UCP patients because a high proportion have heightened sensitivity not only to acid reflux but also to oesophageal distention by non-acid 'volume reflux' and bolus escape on swallowing. 10 Conventional manometryUp to a third of patients with UCP undergoing conventional manometry have abnormal findings. In the absence of dysphagia, however, major oesophageal dysmotility such as occurs in achalasia is rare and the importance of many other findings questionable. 11 This is because 'nonspecific motor dysfunction' , including the condition known as nutcracker oesophagus, is common in GORD and many patients obtain symptomatic relief with acid suppression even though motor function is unchanged. Also, medications that relax oesophageal smooth muscle rarely improve symptoms. Studies have sh...

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Neurophysiologic Assessment of Esophageal Sensory Processing in Noncardiac Chest Pain

Cited by 96 publications

References 46 publications

New technologies to investigate the brain-gut axis

New technologies to investigate the brain-gut axis

Assessment of Gastrointestinal Sensation – A Review

Unexplained (non-cardiac) chest pain

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