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Increased Esophageal Sensitivity to Acid and Saline in Patients With Nonerosive Gastro-esophageal Reflux Disease

Nagahara, Akihito MD, PhD*; Miwa, Hiroto MD, PhD; Minoo, Toshoku MD, PhD*; Hojo, Mariko MD, PhD*; Kawabe, Masato MD*; Osada, Taro MD, PhD*; Kurosawa, Akihiko MD, PhD*; Asaoka, Daisuke MD, PhD*; Terai, Takeshi MD, PhD*; Ohkusa, Toshifumi MD, PhD*; Sato, Nobuhiro MD, PhD*

Journal of Clinical Gastroenterology: November-December 2006 - Volume 40 - Issue 10 - p 891-895
doi: 10.1097/01.mcg.0000225673.76475.9d
Alimentary Tract: Clinical Research

Goals To investigate the features of nonerosive reflux disease (NERD).

Background NERD is not considered as a milder form of erosive gastro-esophageal reflux disease (eGERD). Although the prevalence of NERD was reported to be high in our country, there have been very few studies about NERD.

Study We performed upper gastrointestinal endoscopy to confirm the diagnosis of GERD. The modified acid perfusion test and saline perfusion test were performed in 7 control subjects, 14 NERD, and 11 eGERD patients. The stimulus-response function to acid and saline was quantified by the duration of typical symptom perception (minutes), total sensory intensity rating (0 to 10), and the perfusion sensory score (SS), which was defined as the product of minutes and the sensory intensity rating.

Results The mean value of SS by saline was 0 in control subjects, 12.0 in NERD patients, and 1.5 in eGERD patients (P<0.01 control vs. NERD, P<0.01 NERD vs. eGERD). The mean SS with acid was 0.9 in control subjects, 52.5 in NERD patients, and 23.0 in eGERD patients (P<0.01 control vs. NERD, control vs. eGERD, P<0.05 NERD vs. eGERD). A statistically significant association was shown between the acid and saline perfusion SSs with a correlation coefficient value of r=0.57 in the NERD group (P<0.05).

Conclusions Both eGERD and NERD, but especially NERD, exhibited esophageal hypersensitivity not only to acid but also saline perfusion, suggesting that hyperalgesia to acid and other factors (eg, psychologic and/or autonomic nerve disturbance) may play some roles in symptom generation in NERD.

*Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo

Department of Internal Medicine, Division of Gastroenterology, Hyogo Medical College, 1-1 Mukogawa Nisinomiya, Hyogo, Japan

Reprints: Akihito Nagahara, MD, PhD, Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8721 (e-mail:

Received for publication January 9, 2006; accepted June 14, 2006

© 2006 Lippincott Williams & Wilkins, Inc.