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Multimodal pain stimulations in patients with grade B oesophagitis

¹ Centre for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Denmark, and Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Denmark
² Centre for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Denmark
³ Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
⁴ Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Denmark

Correspondence to:
Correspondence to:
Professor A M Drewes
Centre for Visceral Biomechanics and Pain, Department of Medical Gastroenterology, Aalborg Hospital, DK-9100 Aalborg, Denmark; drewes{at}smi.auc.dk

Aim: To obtain a better understanding of nociceptive processing in patients with oesophagitis.

Patients and methods: Eleven patients with grade B oesophagitis were compared with an age and sex matched group of 16 healthy subjects. A probe was positioned in the lower part of the oesophagus. After preconditioning of the tissue, painful mechanical stimuli were applied as distensions with a bag using an impedance planimetric method. Distensions were done before and after pharmacological impairment of distension induced smooth muscle contractions. Thermal stimulation was performed by recirculating water at 1 and 60°C in the bag. The area under the temperature curve (AUC) represented caloric load. The referred pain area (being a proxy for the central pain mechanisms) to the mechanical stimuli was drawn at maximum pain intensities.

Results: Patients were hyposensitive to mechanical stimuli, as assessed by the distending volume (F = 8.1, p = 0.005). After relaxation of smooth muscle with butylscopolamine, the difference between the two groups was more evident (F = 27.4, p<0.001). AUC for cold stimulation was 1048.6 (242.7) °Cxs in controls and 889.8 (202.6) °Cxs in patients (p = 0.5). For heat stimuli, AUC values were 323.3 (104.1) and 81.3 (32.3) °Cxs in controls and patients, respectively (p = 0.04). The referred pain area to the mechanical stimulations was larger and more widespread in patients (49.3 (6.2) cm² compared with controls 23.9 (7) cm²; p = 0.02).

Conclusions: The data indicate that peripheral sensitisation of heat sensitive receptors and pathways combined with facilitation of central pain mechanisms may explain the symptoms in patients with oesophagitis.

Abbreviations: AUC, area under the temperature curve; CNS, central nervous system; CSA, cross sectional area; GORD, gastro-oesophageal reflux disease; NERD, non-erosive reflux disease; PPI, proton pump inhibitors; VAS, visual analogue scale

Keywords: oesophagitis; experimental pain; acid; sensitisation

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Central sensitisation in visceral pain disorders

B Moshiree, Q Zhou, D D Price, and G N Verne
Gut 2006 55: 905-908. [Abstract] [Full Text] [PDF]

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				B Moshiree, Q Zhou, D D Price, and G N Verne Central sensitisation in visceral pain disorders Gut, July 1, 2006; 55(7): 905 - 908. [Abstract] [Full Text] [PDF]