Quantitative Assessment and Characterization of Visceral Hyperalgesia Evoked by Esophageal Balloon Distention and Acid Perfusion in Patients With Functional Heartburn, Nonerosive Reflux Disease, and Erosive Esophagitis
Quantitative Assessment and Characterization of Visceral Hyperalgesia Evoked by Esophageal Balloon Distention and Acid Perfusion in Patients With Functional Heartburn, Nonerosive Reflux Disease, and Erosive Esophagitis
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功能性胃灼热、非糜烂性反流病和糜烂性食管炎患者食管球囊扩张和酸灌注引起的内脏痛觉过敏的定量评估和表征
DOI：
10.1097/ajp.0b013e3181c8fc83
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发表时间：
2010-05
影响因子：
2.9
通讯作者：
Xu, Guo-ming
中科院分区：
文献类型：
--
作者：
Li, Zhao-shen;Stephens, R. L.;Zou, Duo-wu;Yang, Min;Chen, Dong-feng;Fang, Dian-chun;Xu, Xiao-rong;Wang, Zheng-guo;Xu, Guo-ming
背景和目的食管超敏反应在pH试验阴性、症状指数阴性和质子泵抑制剂（PPI）治疗失败的功能性胃灼热（FH）中的作用尚未确定。本研究的目的是探讨FH、非糜烂性反流病和糜烂性食管炎患者食管球囊扩张和酸灌注诱发的内脏痛觉过敏的特征，并进一步描述FH的病理生理机制。方法21例FH患者（食管酸暴露<3.1%，症状指数<50%，质子泵抑制剂治疗无效）、25例非糜烂性反流病（NERD）患者（食管酸暴露>4%）、23例糜烂性食管炎（EE）患者（LA分级B ~ D）和18例健康对照者入选。机械敏感性包括初始感知阈值（IPT）和疼痛阈值（PT），通过使用Barostat和双随机阶梯扩张方案进行评价。灌注生理盐水和0.1 N HCl后，沿沿着视觉模拟量表对化学敏感性进行分级。结果FH组、NERD组和EE组的基线IPT和PT均低于对照组（均P<0.01）。此外，FH患者的基线PT显著低于NERD（P=0.015）和EE患者（P<0.001）。酸灌注后，FH、NERD和EE患者的平均症状强度评分显著高于对照组（均P<0.001）。FH、NERD和EE患者酸灌注后IPT均显著低于相应的基线值（均P<0.01）。FH组（P=0.026）和EE组（P<0.001）的PT均显著低于相应的基线值。FH组酸灌注后PT明显低于NERD组（P<0.001）。结论FH患者对机械或化学刺激较NERD患者敏感。食管酸敏感性化学感受器的增敏作用可能对压力敏感性机械感受器产生重要影响，在食管内脏痛觉过敏过程中存在协同作用。
Background and ObjectivesThe role of esophageal hypersensitivity in functional heartburn (FH) with negative pH test, negative symptom index, and the proton pump inhibitor (PPI) failure has not been established. The aim of this study was to investigate the characterization of visceral hyperalgesia evoked by esophageal balloon distention and acid perfusion in patients with FH, nonerosive reflux disease, and erosive esophagitis and further characterize the pathophysiologic mechanism of FH. MethodsA total of 21 FH patients (with esophageal acid exposure <3.1% and a symptom index<50% and nonresponse to a therapeutic trial with proton pump inhibitors, 25 Nonerosive reflux disease (NERD) patients (with esophageal acid exposure>4%), 23 erosive esophagitis (EE) patients (LA grade B to D), and 18 healthy controls were recruited in the study. Mechanosensitivity including the initial perception threshold (IPT) and pain threshold (PT) was evaluated by using a Barostat with a double-random staircase distension protocol. Chemosensitivity was graded along a visual analog scale after perfusion of saline and 0.1 N HCl. ResultsThe baseline IPTs and PTs were all lower in patients with FH, NERD, and EE than in the controls (all P<0.01). In addition, the baseline PT in FH patients was significantly lower than those in NERD (P=0.015) and EE patients (P<0.001). After acid perfusion, the mean symptom intensity scores were significantly greater in patients with FH, NERD, and EE than those in the controls (all P<0.001). The postacid perfusion IPTs in patients with FH, NERD, and EE were all significantly lower than the corresponding baseline values (all P<0.01). The PTs in FH (P=0.026) and EE patients (P<0.001) were significantly lower than the corresponding baseline values. Moreover, the postacid perfusion PT was significantly lower in FH patients than in NERD patients (P<0.001). ConclusionsFH patients are more sensitive to mechanical or chemical stimuli than NERD patients. Sensitization of esophageal acid-sensitive chemoreceptors may exert a significant influence on the pressure-sensitive mechanoreceptors, and there is the cooperative interaction in the process of esophageal visceral hyperalgesia.
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影响因子：
9.8
作者：
W. Hu;Christopher J. Martin;N. Talley
通讯作者：
W. Hu;Christopher J. Martin;N. Talley
影响因子：
7.6
作者：
Cicala, M;Emerenziani, S;Pallone, F
通讯作者：
Pallone, F
影响因子：
24.5
作者：
Lundell, LR;Dent, J;Wallin, L
通讯作者：
Wallin, L
影响因子：
0.8
作者：
N. Shields;L. Bradley;J. Richter;T. J. Pulliam;Julie M. Haile;I. Scarinci;Cathy A. Schan;C. Dalton;A. Salley
通讯作者：
N. Shields;L. Bradley;J. Richter;T. J. Pulliam;Julie M. Haile;I. Scarinci;Cathy A. Schan;C. Dalton;A. Salley
影响因子：
2.9
作者：
Nagahara, Akihito;Miwa, Hiroto;Sato, Nobuhiro
通讯作者：
Sato, Nobuhiro