Gastroenterology

Gastroenterology

Volume 115, Issue 6, December 1998, Pages 1353-1362
Gastroenterology

Alimentary Tract
Identification and characterization of cerebral cortical response to esophageal mucosal acid exposure and distention

https://doi.org/10.1016/S0016-5085(98)70013-7Get rights and content

Abstract

Background & Aims: Esophageal acid exposure is a common occurrence in healthy individuals and patients with esophagitis. Clinically, perception of this exposure ranges from no perception to severe heartburn and chest pain. Cerebral cortical response to esophageal mucosal contact to acid has not been systematically studied. The aim of this study was to elucidate cerebral cortical response to esophageal acid exposure in normal individuals by functional magnetic resonance imaging (FMRI). Methods: We studied 10 normal healthy volunteers. Cortical FMRI response to 10 minutes of intraesophageal perfusion of 0.1N HCl (1 mL/min) was determined, and the results were compared with those of saline infusion and balloon distention. Results: Acid perfusion did not induce heartburn or chest pain but increased FMRI signal intensity by 6.7% ± 2.0% over the preperfusion values. No increase was detected for saline infusion. FMRI signal intensity to balloon distention was similar to that of acid perfusion. Activation latency, activation to peak, and the deactivation periods for response to acid perfusion were significantly longer than those of balloon distention (P < 0.05). Conclusions: Contact of esophageal mucosa with acid, before inducing heartburn, evokes a cerebral cortical response detectable by FMRI. Temporal characteristics of this response are significantly different from those induced by esophageal balloon distention.

GASTROENTEROLOGY 1998;115:1353-1362

Section snippets

Subjects

Ten healthy normal volunteers (6 women and 4 men; age range, 19–44 years) were studied. All volunteers filled out a detailed health-related questionnaire before the study and did not have any present or previous history of reflux disease, dysphagia, or other gastrointestinal-related diseases. All study protocols were approved by the Human Research Review Committee of the Medical College of Wisconsin, and the subjects gave written informed consent before the studies.

MRI scanning

FMRI has been shown to

Cerebral cortical FMRI response to esophageal saline and acid perfusion

Although saline perfusion elicited no detectable change in cerebral cortical FMRI activity, intraesophageal acid perfusion produced a characteristic response in all studied subjects. As shown in Figure 4A, cerebral cortical FMRI activity was concentrated in the posterior cingulate, parietal, and anteromesial frontal lobes.

. (A) Regions of activation for normalized brain volume using the Talairach coordinate system in the midsagittal, midaxial, and midcoronal planes for all acid perfusion scans

Discussion

In this study we characterized the cerebral cortical response to esophageal mucosal acid exposure and compared the findings with that of esophageal balloon distention. Study findings indicate that chemical stimulation of esophageal mucosa by 0.1N HCl at a threshold below the development of heartburn is relayed to the cerebral cortex and induces neuronal activity detectable by the FMRI technique. Study findings also indicate that a cerebral FMRI response to esophageal acid exposure develops

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    Address requests for reprints to: Reza Shaker, M.D., Division of Gastroenterology and Hepatology, Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Avenue, Milwaukee, Wisconsin 53226. Fax: (414) 456-6215.

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