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Motility and visceral sensation
Cardiac autonomic function and oesophageal acid sensitivity in patients with non-cardiac chest pain
  1. G Tougasa,
  2. R Spaziania,
  3. S Hollerbacha,
  4. V Djuricd,
  5. C Pange,
  6. A R M Uptonc,
  7. E L Fallenb,
  8. M V Kamathe
  1. aDivision of Gastroenterology, McMaster University, Hamilton, Ontario, Canada, bDivision of Cardiology, McMaster University, Hamilton, Ontario, Canada, cDivision of Neurology, McMaster University, Hamilton, Ontario, Canada, dDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada, eDepartment of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
  1. Dr G Tougas, Department of Medicine, Division of Gastroenterology, Room 3N5D, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z1, Canada. tougasg{at}mcmaster.ca

Abstract

BACKGROUND Acid reflux can elicit non-cardiac chest pain (NCCP), possibly through altered visceral sensory or autonomic function. The interactions between symptoms, autonomic function, and acid exposure are poorly understood.

AIM To examine autonomic function in NCCP patients during exposure to oesophageal acid infusion.

SUBJECTS AND METHODS Autonomic activity was assessed using power spectral analysis of heart rate variability (PSHRV), before and during oesophageal acidification (0.1 N HCl), in 28 NCCP patients (40.5 (10) years; 13 females) and in 10 matched healthy controls. Measured PSHRV indices included high frequency (HF) (0.15–0.5 Hz) and low frequency (LF) (0.06–0.15 Hz) power to assess vagal and sympathetic activity, respectively.

RESULTS A total of 19/28 patients had angina-like symptoms elicited by acid. There were no significant manometric changes observed in either acid sensitive or insensitive patients. Acid sensitive patients had a higher baseline heart rate (82.9 (3.1) v 66.7 (3.5) beats/min; p<0.005) and lower baseline vagal activity (HF normalised area: 31.1 (1.9)% v 38.9 (2.3)%; p< 0.03) than acid insensitive patients. During acid infusion, vagal cardiac outflow increased (p<0.03) in acid sensitive but not in acid insensitive patients.

CONCLUSIONS Patients with angina-like pain during acid infusion have decreased resting vagal activity. The symptoms elicited by perception of acid are further associated with a simultaneous increase in vagal activity in keeping with a vagally mediated pseudoaffective response.

  • reflux disease
  • non-cardiac chest pain
  • acid reflux
  • autonomic nervous system
  • vagal response
  • sympathetic activity
  • heart rate variability
  • power spectrum analysis

https://doi.org/10.1136/gut.49.5.706

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