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Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e3182478826
Original Articles

Acid Sensitization of Esophageal Mucosal Afferents: Implication for Symptom Perception in Patients Across the Gastroesophageal Reflux Disease Spectrum

Szczesniak, Michal Marcin PhD; Fuentealba, Sergio Enrique BSc; Cook, Ian J. PhD

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Background: Sensitization of esophageal chemoreceptors, either directly by intermittent acid exposure or indirectly through esophagitis-associated inflammatory mediators, is likely to be the mechanism underlying the perception of heartburn.

Aims: To compare basal esophageal sensitivity with electrical stimulation and acid, and to compare the degree of acid-induced sensitization in controls and in patient groups across the entire spectrum of gastroesophageal reflux disease: erosive oesophagitis (EO), nonerosive reflux disease (NERD), and functional heartburn (FH).

Methods: Esophageal sensory and pain thresholds to electrical stimulation were measured before, 30, and 60 minutes after an intraesophageal infusion of saline or HCl. Patients received a 30-minute infusion of 0.15 M HCl and controls were randomized to receive either HCl (n=11) or saline (n=10). After electrical sensory threshold testing, participants received another 30-minute infusion of HCl to determine whether sensitivity to acid is increased by prior acid exposure

Results: All patient groups had higher basal sensory thresholds than healthy controls (controls, 13±1.4 mA; FH, 20±5.1 mA; NERD, 21±5.1 mA; EO, 23±5.4 mA; P<0.05). Acute esophageal acid exposure reduced sensory thresholds to electrical stimulation in FH and NERD patients (P<0.05). The level of acid sensitivity during the first HCl infusion was comparable between all patient groups and controls. The secondary infusion caused increased discomfort in all participants (P<0.01). This acid-induced sensitization to HCl was significantly elevated in the patient groups ( P<0.05).

Conclusions: (1) Esophageal acid infusion sensitizes it to subsequent electrical and chemical stimulation. (2) The acid-related sensitization is greater in gastroesophageal reflux disease than in controls and may influence in part symptom perception in this population. (3) Acid-related sensitization within the gastroesophageal reflux disease population is not dependant on mucosal inflammation.

© 2013 Lippincott Williams & Wilkins, Inc.

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