Are Esophageal Motility Abnormalities Produced During the Intraesophageal Acid Perfusion Test?

Abstract

Many years ago, it was proposed that the symptoms of heartburn correlated more closely with acid-induced esophageal motility abnormalities than with the presence of inflammation. This concept, however, has not been evaluated by modern manometric techniques. We monitored intraesophageal pressures during acid perfusion (O.1N hydrochloric acid) in 17 reflux patients with gross esophagitis and positive pain response and 17 age-matched controls. Using a low-compliance infusion system, amplitude, duration, velocity, and the presence of simultaneous and repetitive contractions in the body of the esophagus were evaluated. Amplitude did not change in either group. Duration did increase significantly during acid perfusion in reflux patients, but not in controls. Mean duration between groups, however, was similar before and during acid perfusion. No simultaneous contractions were observed, while three patients and two controls had repetitive contractions. A significant decrease in velocity was observed in both groups during acid perfusion. These studies indicate that acid-induced motor abnormalities are neither a common accompaniment nor necessary for the production of acid-induced pain in the esophagus.

Sustained esophageal contraction: a motor correlate of heartburn symptom

“…However, standard esophageal pressure recordings failed to demonstrate a motor correlate of heartburn symptoms. Furthermore, acid infusion into the esophagus does not induce any predictable changes in the esophageal motility as measured by intraluminal pressure recording techniques (6,17). Therefore, the precise mechanism of heartburn is unclear.…”

Effects of intraluminal acidification on oesophageal motor activity.

“…9 10 In these studies, however, oesophageal motor activity during acid per-fusion was not compared with equivalent control periods, the high infusion rates prevented discrimination of the effect of acidification from that of intraluminal distension and, with few exceptions," the acid infusion time was not standardised. In addition, only the motor activity of the distal oesophageal body has been assessed.…”

Gamma‐aminobutyric acid receptor type B agonist baclofen inhibits acid‐induced excitation of secondary peristalsis but not heartburn sensation

“…The precise mechanism by which intraluminal acid infusion influences triggering of secondary peristalsis remains unclear. The effects of experimental acidification on esophageal motility have been reported by earlier studies, which showed controversial results regarding manometric parameters of primary peristalsis . Alterations in esophageal motility during acid infusion are also associated with the occurrence of heartburn or chest pain .…”

“…The effects of experimental acidification on esophageal motility have been reported by earlier studies, which showed controversial results regarding manometric parameters of primary peristalsis . Alterations in esophageal motility during acid infusion are also associated with the occurrence of heartburn or chest pain . Although previous studies in animal model suggested that acidic liquids lowered threshold volumes for initiating a secondary peristaltic response, subsequent studies on the influence of esophageal acidification on secondary peristalsis are very few .…”