Oesophageal afferent pathway sensitivity in non‐erosive reflux disease

Abstract

Patients with non-erosive reflux disease (NERD) report symptoms which commonly fail to improve on conventional antireflux therapies. Oesophageal visceral hyperalgaesia may contribute to symptom generation in NERD and we explore this hypothesis using oesophageal evoked potentials. Fifteen endoscopically confirmed NERD patients (four female, 29-56 years) plus 15 matched healthy volunteers (four female, 23-56 years) were studied. All patients had oesophageal manometry/24-h pH monitoring and all subjects underwent evoked potential and sensory testing, using electrical stimulation of the distal oesophagus. Cumulatively, NERD patients had higher sensory thresholds and increased evoked potential latencies when compared to controls (P = 0.01). In NERD patients, there was a correlation between pain threshold and acid exposure as determined by DeMeester score (r = 0.63, P = 0.02), with increased oesophageal sensitivity being associated with lower DeMeester score. Reflux negative patients had lower pain thresholds when compared to both reflux positive patients and controls. Evoked potentials were normal in reflux negative patients but significantly delayed in the reflux positive group (P = 0.01). We demonstrate that NERD patients form a continuum of oesophageal afferent sensitivity with a correlation between the degree of acid exposure and oesophageal pain thresholds. We provide objective evidence that increased oesophageal pain sensitivity in reflux negative NERD is associated with heightened afferent sensitivity as normal latency evoked potential responses could be elicited with reduced afferent input. Increased oesophageal afferent pain sensitivity may play an important role in a subset of NERD and could offer an alternate therapeutic target.

Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes

“…In this study, two patients reported chest pain during meal period, although endoscopic removal of the capsule was not necessary. The proposed mechanism to chest pain in these patients probably is related to abnormalities in central or peripheral visceral nociception, in particular, decreased threshold in generation or perception of symptoms (9) . Similar to other authors (10,31) patients in this study did not complain of pharyngeal discomfort or interference in their daily activities.…”

Demographic, Clinical, and Psychological Characteristics of the Heartburn Groups Classified Using the Rome III Criteria and Factors Associated with the Responsiveness to Proton Pump Inhibitors in the Gastroesophageal Reflux Disease Group

“…In addition, the same symptom can be produced by a physiological intraesophageal acid exposure [7]. Increased esophageal sensitivity to esophageal distension or stimulation [8,9,10,11], non-acid reflux [12, 13], and esophageal motor abnormalities [14] are suggested to play a role in the genesis of heartburn. Based on ambulatory esophageal pH monitoring, patients with no evidence of esophagitis on endoscopy can be subdivided as having excessive or normal esophageal acid exposure time.…”

Predictive Factors of Response to Proton Pump Inhibitors in Korean Patients With Gastroesophageal Reflux Disease

“…27 In addition, a previous study found that increased sensitivity to esophageal pain was present in a subset of PPI-resistant NERD patients. 28 Therefore, reflux perception and increased sensitivity to pain may be associated with different responses to PPI therapy in ERD vs NERD patients. Our study revealed a significant association between BMI and response to PPI.…”