Original article: The effect of argon plasma coagulation ablation on esophageal motility and chemoreceptor sensitivity in Barrett's esophagus patients

Abstract

Patients with Barrett's esophagus usually demonstrate impaired esophageal motility, which affects acid clearance, together with reduced chemo-receptor sensitivity and symptom severity. Ablative endoscopic techniques are now used to eliminate Barrett's cells. The hypothesis for this study was that ablation with argon plasma coagulation (APC) may affect esophageal sensitivity and motility in patients with Barrett's esophagus, and the aim of this study was to assess differences in these parameters before and after APC treatment. Twenty patients with Barrett's esophagus were investigated before and after APC therapy. After standard pull through manometry, water bolus aliquots were given to assess primary peristalsis and rapid water and air bolus injections to assess secondary peristalsis. Sensitivity studies were carried out using weak solutions of either hydrochloric acid or sodium hydroxide, together with saline washouts. Onset time for typical symptoms (t), sensory intensity rating (I), and a sensory score (SS) = (t) x (I)/100 was observed. There were no significant differences in the lower esophageal sphincter pressures (13.6 mm Hg versus 12.6 mm Hg, P= 0.8) and successful test swallows (3 mm Hg versus 5 mm Hg, P= 0.5) before and after treatment, but there was a trend for secondary peristalsis to improve (air bolus 0 versus 2, P= 0.05, water bolus 0 versus 1, P= 0.07). Sensitivity studies showed a smaller sensitivity intensity rating to both acid (61 versus 31, P= 0.02) and alkaline (91 versus 64, P= 0.03) after treatment. In conclusion, we have shown no substantive changes in esophageal motility after ablation of Barrett's esophagus cells, but have demonstrated reduced sensitivity to reflux type solutions.

Patients with Barrett's esophagus are hypersensitive to acid but hyposensitive to other stimuli compared with healthy controls

“…Selection bias is very possible with a dropout of this scale and results of small exploratory studies like the present must always be interpreted with caution. Yet, the patient population investigated seems comparable to large cohorts of BE patients with regards to age, BMI, symptoms and HH . Since the ambulatory pH‐impedance data were only available for half the controls, these should be interpreted carefully.…”

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett‘s Esophagus Than in Healthy Controls

“…Considering whether the investigated BE population is representative overall, also taking into account sample size, other largely similar studies have included widely comparable populations. 25,[52][53][54][55] Yet, the older age and higher BMI in patients compared with controls in the present study and patient heterogeneity such as eg, presence of EE could pose a problem. However, specific analyses on these subjects to detect possible confounding did not change results.…”