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Multimodal pain stimulations in patients with grade B oesophagitis
  1. A M Drewes1,
  2. H Reddy2,
  3. J Pedersen2,
  4. P Funch-Jensen3,
  5. H Gregersen1,
  6. L Arendt-Nielsen4
  1. 1Centre 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. 2Centre for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Denmark
  3. 3Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
  4. 4Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Denmark
  1. 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

Abstract

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) °C×s in controls and 889.8 (202.6) °C×s in patients (p = 0.5). For heat stimuli, AUC values were 323.3 (104.1) and 81.3 (32.3) °C×s 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.

  • 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
  • oesophagitis
  • experimental pain
  • acid
  • sensitisation

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Footnotes

  • Published online first 9 August 2005

  • Conflict of interest: None declared.

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