Alimentary TractDifferential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans☆,☆☆
Section snippets
Study subjects
Ten normal subjects (9 men and 1 woman; mean age, 38.2 ± 4.7 years; age range, 19–61 years) and 11 patients with GERD (11 men; mean age, 43.9 ± 5.4 years; age range, 24–86 years) were recruited into the study. All normal subjects were evaluated by a personal interview, validated GERD symptom questionnaire,14 24-hour esophageal pH monitoring, and an acid perfusion test to exclude apparent or occult GERD. Inclusion into the patients with GERD group required typical GERD symptoms (heartburn and
Patient characteristics
Of the 11 patients, 7 rated their heartburn at baseline as mild, 3 as moderate, and 1 as severe. Based on endoscopic grading at baseline, 3 patients had a normal esophagus (grade 0), 7 showed mild-to-moderate esophagitis (grade 1–3), and 1 showed severe esophagitis (grade 4–5). Table 1 summarizes the clinical characteristics of control subjects and patients with GERD, including results of 24-hour esophageal pH monitoring and upper endoscopy grading.
Discussion
We have shown that patients with mild-to-moderate GERD show enhanced sensitivity of the esophagus to brief HCl exposure but not to distention. In the majority of patients, this enhanced chemosensitivity is reduced or abolished by prolonged acid suppression. Although other mechanisms that could underlie enhanced chemosensitivity were not ruled out in the current study, it may be assumed that chronic tissue injury related to acid exposure is an important factor. In contrast, the absence of an
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Address requests for reprints to: Emeran A. Mayer, M.D., UCLA/Center for Ulcer Research and Education Neuroenteric Disease Program, West Los Angeles VA Medical Center, Building 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, California 90073. Fax: (310) 794-2864.
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Supported in parts by grant DK 48351 from the National Institutes of Health, by a research grant from Astra Merck, and by funds from the Veterans Administration.