Effect of an acute intraluminal administration of capsaicin on oesophageal motor pattern in GORD patients with ineffective oesophageal motility

Abstract

Ineffective oesophageal motility (IOM) is a functional disorder affecting about 50% of gastro-oesophageal reflux disease (GORD) patients. This disease in a severe form limits the clearing ability of the oesophagus and is considered one of the predictive factors for poorer GORD resolution. Capsaicin, the active compound of red pepper, exerts a prokinetic effect on oesophageal motility in healthy subjects by increasing the amplitude of body waves, even if no evidence exists on its possible role in situations of reduced motility. The aim of the study was to evaluate the effect of an acute administration of capsaicin on the oesophageal motor pattern in a group of GORD patients affected by severe IOM. Twelve GORD patients with severe IOM received an intra-oesophageal administration of 2 mL of a red pepper-olive oil mixture and 2 mL of olive oil alone serving as a control during a stationary manometry. The motor patterns of the oesophageal body and lower oesophageal sphincter (LOS) were analysed at baseline and after the infusion of the two stimuli. The administration of capsaicin induced a significant improvement in oesophageal body contractility when compared with baseline. The velocity of propagation of waves and the LOS basal tone remained unchanged. The motor pattern was unaltered by the administration of olive oil alone. An acute administration of capsaicin seems to improve the motor performance of the oesophageal body in patients with ineffective motility. Whether this could represent the basis for further therapeutic approaches of GORD patients needs further study.

TRP channels as therapeutic targets: hot property, or time to cool down?

“…That there is a role for TRPV1 and other TRP channels in sensory signalling from the bowel and other organs is clear. This role extends, as shown in the study by Grossi et al ., 13 to dysmotility and sensation. Although a direct role in pathophysiology is not proven, this is not a negative observation with respect to therapeutic potential for modulators of these receptors.…”

Ineffective oesophageal motility: Manometric subsets exhibit different symptom profiles

“…This was not the case, and our findings are consistent with those of Lemme et al, who found that the proportion of low-amplitude swallows did not differ between IOM patients with erosive versus non-erosive GORD [23] . It is feasible that the presence of propagating (albeit low-amplitude) sequences equates to more efficient clearance [24] of refluxate in these patients, and novel approaches to stimulating clearance [25] may prove beneficial in this IOM subset. Another explanation for the high heartburn prevalence is that these patients exhibit oesophageal hypersensitivity [26] .…”

Transient receptor potential (TRP) channels as drug targets for diseases of the digestive system

“…Acute ingestion of capsaicin has a protective effect against aspirin-induced erosions in the gastric mucosa of human volunteers (Yeoh et al, 1995). In addition, capsaicin can improve esophageal motility in patients with gastro-esophageal reflux disease (Grossi et al, 2006). Prolonged intake of capsaicin appears to desensitize afferent nerve fibers against noxious stimulation of the upper GI tract.…”