The Role of Esophageal Hypersensitivity in Functional Esophageal Disorders

Farmer, Adam D.; Ruffle, James K.; Aziz, Qasim

doi:10.1097/mcg.0000000000000757

Cited by 35 publications

(13 citation statements)

References 75 publications

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“…It has been reported that 30.0% of patients with refractory reflux symptoms has a FH, which is mainly caused by high esophageal hypersensitivity, 23 which is consistent with the low positive rate of salivary pepsin observed in this study. Moreover, a study found more episodes of reflux in patients with EES than those without reflux symptoms by 24-hour pH monitoring, among which episodes of reflux could be detected in 49.2% of patients with respiratory symptoms.…”

Section: Discussionsupporting

confidence: 91%

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Wang

Lang

et al. 2020

J Neurogastroenterol Motil

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Background/AimsTo determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. MethodsOverall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES). ResultsCompared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett's esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002). ConclusionsSalivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency. (J Neurogastroenterol Motil 2020;26:74-84)

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Section: Discussionsupporting

confidence: 91%

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Wang

Lang

et al. 2020

J Neurogastroenterol Motil

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“…Our findings have potential therapeutic implications. Heartburn and chest pain are common symptoms in functional oesophageal disorders, such as reflux hypersensitivity syndrome 42 . Although proton pump inhibitors (PPIs) are the gold standard for the treatment of gastro‐oesophageal reflux disease, a substantial proportion of such patients fail to respond 43 .…”

Section: Discussionmentioning

confidence: 99%

Transcutaneous vagus nerve stimulation prevents the development of, and reverses, established oesophageal pain hypersensitivity

Farmer

Albusoda

Amarasinghe

et al. 2020

Aliment Pharmacol Ther

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Summary Background The vagus nerve exerts an anti‐nociceptive effect on the viscera. Aim To investigate whether transcutaneous vagal nerve stimulation (t‐VNS) prevents the development of and/or reverses established visceral hypersensitivity in a validated model of acid‐induced oesophageal pain. Methods Before and after a 30‐minute infusion of 0.15M hydrochloric acid into the distal oesophagus, pain thresholds to electrical stimulation were determined in the proximal non‐acid exposed oesophagus. Validated sympathetic (cardiac sympathetic index) and parasympathetic (cardiac vagal tone [CVT]) nervous system measures were recorded. In study 1, 15 healthy participants were randomised in a blinded crossover design to receive either t‐VNS or sham for 30 minutes during acid infusion. In study 2, 18 different healthy participants were randomised in a blinded crossover design to receive either t‐VNS or sham, for 30 minutes after acid infusion. Results Study 1: t‐VNS increased CVT (31.6% ± 58.7 vs −9.6 ± 20.6, P = 0.02) in comparison to sham with no effect on cardiac sympathetic index. The development of acid‐induced oesophageal hypersensitivity was prevented with t‐VNS in comparison to sham (15.5 mA per unit time (95% CI 4.9 ‐ 26.2), P = 0.004). Study 2: t‐VNS increased CVT (26.3% ± 32.7 vs 3 ± 27.1, P = 0.03) in comparison to sham with no effect on cardiac sympathetic index. t‐VNS reversed established acid‐induced oesophageal hypersensitivity in comparison to sham (17.3mA/unit time (95% CI 9.8‐24.7), P = 0.0001). Conclusions t‐VNS prevents the development of, and reverses established, acid‐induced oesophageal hypersensitivity. These results have therapeutic implications for the management of visceral pain hypersensitivity.

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“…As described earlier in this paper, there is considerable overlap in the pathophysiology of FGIDs, with studies in both upper and lower FGIDs consistently demonstrating visceral hypersensitivity to mechanical or chemical stimuli. 90,91 Indeed, there is emerging evidence that 'esophagus-focused hypnotherapy' is both feasible and acceptable to patients with functional esophageal disorders. 92,93 Importantly, the recently updated diagnostic criteria for this group of disorders reflect advances in motility diagnostics.…”

Section: G Ut-fo Cus Ed Hypnother Apy In Fun C Tional Upper G a S Tmentioning

confidence: 99%

Gut‐focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence‐base, practical aspects, and the Manchester Protocol

Vasant

Whorwell

2019

Neurogastroenterology Motil

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Background Despite their high prevalence and advances in the field of neurogastroenterology, there remain few effective treatment options for functional gastrointestinal disorders (FGIDs). It is recognized that approximately 25% of sufferers will have symptoms refractory to existing therapies, causing significant adverse effects on quality of life and increased healthcare utilization and morbidity. Gut‐focused hypnotherapy, when delivered by trained therapists, has been shown to be highly effective in severe refractory FGIDs. However, hypnotherapy continues to be surrounded by much misunderstanding and skepticism. Purpose The purpose of this review is to provide a contemporary overview of the principles of gut‐focused hypnotherapy, its effects on gut‐brain interactions, and the evidence‐base for its efficacy in severe FGIDs. As supplementary material, we have included a hypnotherapy protocol, providing the reader with an insight into the practical aspects of delivery, and as a guide, an example of a script of a gut‐focused hypnotherapy session.

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The Role of Esophageal Hypersensitivity in Functional Esophageal Disorders

Cited by 35 publications

References 75 publications

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

Transcutaneous vagus nerve stimulation prevents the development of, and reverses, established oesophageal pain hypersensitivity

Gut‐focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence‐base, practical aspects, and the Manchester Protocol

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