Acid Sensitization of Esophageal Mucosal Afferents

Szczesniak, Michal; Fuentealba, Sergio E.; Cook, Ian J.

doi:10.1097/ajp.0b013e3182478826

Cited by 11 publications

(3 citation statements)

References 46 publications

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“…GerdQ scores can assess the subjective symptomatic degree of GERD [ 12 ]. However, the severity of subjective symptoms in GERD is not only caused by acidity exposure, but also has a close correlation with visceral high sensitivity [ 15 ]. Our results only showed that the length of the PPGAP in the GERD patients had a significantly positive correlation with the GerdQ score.…”

Section: Discussionmentioning

confidence: 99%

The Characteristics of Postprandial Proximal Gastric Acid Pocket in Gastroesophageal Reflux Disease

Liu

Feng

et al. 2018

Med Sci Monit

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BackgroundPostprandial proximal gastric acid pocket (PPGAP) plays important roles in gastroesophageal reflux disease (GERD). In this study, we analyzed the characteristics of PPGAP in GERD.Material/MethodsThere were 17 normal participants and 20 GERD patients who completed a gastroesophageal reflux disease questionnaire (GerdQ) and underwent a gastroscopy, a high-resolution manometry, an esophageal 24-hour pH monitoring, and a station pull-through pH monitoring to assess their symptomatic degree, endoscopic change, acid exposure, and PPGAP.ResultsPPGAP was present in all participants. Compared with normal participants, the PPGAP in GERD patients was significantly different, thus the disappearing time was significantly later (p<0.001), the lasting time was significantly longer (p<0.001), the length was significantly longer (p<0.001), and the lowest pH and the mean pH were significantly lower (p<0.001). The length of PPGAP in GERD patients was positively correlated with GerdQ score (p<0.05). The disappearing time, the lasting time, and the length of PPGAP in GERD patients was positively correlated with the DeMeester score (p<0.01). The lowest pH and the mean pH of PPGAP in GERD patients was negatively correlated with the DeMeester score (p<0.001).ConclusionsPPGAP was generally present. PPGAP in GERD patients had characteristics of long time period, long length, and high acidity. Its length was positively correlated with subjective symptomatic degree. Its period, length, and acidity were positively correlated with the objective acid exposure. PPGAP seems to be the originator of acid reflux events and plays important roles in GERD.

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Section: Discussionmentioning

confidence: 99%

The Characteristics of Postprandial Proximal Gastric Acid Pocket in Gastroesophageal Reflux Disease

Liu

Feng

et al. 2018

Med Sci Monit

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“…Therefore, further investigation using GERD patients is needed to clarify the relationship between pH changes in different sites of the esophagus and generation of GERD symptoms during acid infusion, though a difference in sensitivity to acid between the upper and lower esophagus is also considered to be present in those patients 1-5. It was previously reported that an esophageal acid infusion induced stronger reflux symptoms in GERD patients compared to healthy controls 12. Indeed, the symptoms observed in our study were not strong.…”

Section: Discussionmentioning

confidence: 99%

Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults

Ohara

Furuta

Adachi

et al. 2013

J Neurogastroenterol Motil

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Background/AimsThe sensitivity of the upper and lower esophageal mucosa to acid is considered to differ. We investigated the relationship between pH changes in different sites of the esophagus and generation of gastroesophageal reflux symptoms during an acid infusion test.MethodsAn acid infusion catheter was placed at 5 or 15 cm above the lower esophageal sphincter (LES) in 18 healthy volunteers, while a 2-channel pH sensor catheter was also placed in each with the sensors set at 5 and 15 cm above the LES. Solutions containing water and hydrochloric acid at different concentrations were infused through the infusion catheter.ResultsAcid infusion in the upper esophagus caused a pH drop in both upper and lower esophageal sites, whereas that in the lower esophagus resulted in a significant pH drop only in the lower without a corresponding pH decline in the upper esophagus. Stronger heartburn, chest pain, and chest oppression symptoms were noted when acid was infused in the upper as compared to the lower esophagus, while increased intra-esophageal acidity strengthened each symptom. Regurgitations caused by upper and lower esophageal acid infusions were similar, and not worsened by a larger drop in intra-esophageal pH. Chest pain was caused only by lowered intra-esophageal pH, while heartburn, chest oppression, and regurgitation were induced by a less acidic solution.ConclusionsHigher intra-esophageal acidity caused stronger heartburn, chest pain, and chest oppression symptoms. However, regurgitation was not significantly influenced by intra-esophageal acidity. The upper esophagus showed higher acid sensitivity than the lower esophagus.

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“…It can be perceived as heartburn and regurgitation [33]. Sensitization of the esophageal mucosa by acid was described and these mechanistic studies offered an explanation for esophageal hypersensitivity to other stimuli such as balloon distention in patients with GERD [38]. Obesity was described as an important independent risk factor for GERD [39].…”

Section: Changes In the Diagnosis And Treatment Of Gerd And Nerd Over...mentioning

confidence: 99%

Developments in Gastroesophageal Reflux Disease over the Last 40 Years

Vakil

2023

Dig Dis

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Background: The last 40 years have seen a remarkable change in our understanding of reflux disease. Summary: These changes encompass disease definition and impact, pathophysiology, diagnostic testing, regulatory oversight of clinical trials, pharmacotherapy, endoscopic, and surgical treatment. We have also seen a number of promising therapies fail. Key Messages: The future holds the promise of further advances. Adaptive artificial intelligence will take over diagnostics in manometry and pH impedance testing and patient-driven outcomes may be changed by interactions with artificial intelligence rather than humans. Changes in chip technology will allow higher resolution chips to be carried on smaller devices making extra-esophageal areas where reflux may play a role more accessible to prolonged observation and testing.

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Acid Sensitization of Esophageal Mucosal Afferents

Cited by 11 publications

References 46 publications

The Characteristics of Postprandial Proximal Gastric Acid Pocket in Gastroesophageal Reflux Disease

The Characteristics of Postprandial Proximal Gastric Acid Pocket in Gastroesophageal Reflux Disease

Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults

Developments in Gastroesophageal Reflux Disease over the Last 40 Years

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