Evidence for oesophageal visceral hypersensitivity and aberrant symptom referral in patients with globus
Evidence for oesophageal visceral hypersensitivity and aberrant symptom referral in patients with globus
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DOI：
10.1111/j.1365-2982.2009.01316.x
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发表时间：
2009-11-01
影响因子：
3.5
通讯作者：
Cook, I. J.
中科院分区：
文献类型：
--
作者：
Chen, C. L.;Szczesniak, M. M.;Cook, I. J.
我们检验了以下假设：球症患者表现出食管内脏高敏感性和食管刺激的内脏-躯体介导异常。通过食管球囊扩张和电刺激对9例球形症患者的食管内脏感觉进行了评估，并与11名健康对照者进行了比较。测定食管感知和疼痛阈值。受试者在身体地图上记录对每个刺激的胸部内脏参考面积。所有患者报告的第一次感觉球囊体积在2和6 mL之间，而对照组报告的第一次感觉球囊体积在3和14 mL之间（P = 0.03）。所有患者在球囊体积为5 - 12 mL时报告疼痛，而对照组在球囊体积为8 - 20 mL时出现疼痛（P = 0.001）。在对食管的电刺激反应中，患者和对照组表现出相当的感觉阈值。在对食管球囊扩张的反应中，9名患者中有7名患者（但没有对照组）将感觉提到胸骨上切迹或胸骨上切迹以上的区域（P = 0.001）。同样，在食管电刺激反应中观察到内脏-躯体转诊模式的显著差异（P = 0.03）。球形症患者表现出食管内脏对机械扩张的高敏感性。对牵拉和电刺激的不同反应可能表明超敏反应是外周而不是中枢现象。机械刺激和电刺激引起的食管感觉的异常转介支持了将症状转介到颈部可能是一个中心现象的假设。
P>We tested the hypotheses that globus patients demonstrate oesophageal visceral hypersensitivity and aberrant viscerosomatic referral of oesophageal stimuli. Oesophageal visceral perception was assessed by oesophageal balloon distension and electrical stimulation in nine patients with globus and compared with 11 healthy controls. Oesophageal perception and pain thresholds were determined. Subjects recorded the area of thoracic viscerosomatic referral on a body map in response to each stimulus. All the patients reported their first sensation at balloon volumes between 2 and 6 mL whereas controls reported their first sensation at volumes between 3 and 14 mL (P = 0.03). All the patients reported pain at balloon volumes between 5 and 12 mL whereas controls experienced pain at volumes between 8 and 20 mL (P = 0.001). In response to electrical stimulation to the oesophagus patients and controls demonstrated comparable sensory thresholds. In response to oesophageal balloon distension seven of nine patients, but no controls, referred the sensation to the region at or above the suprasternal notch (P = 0.001). Similarly, significant differences in viscerosomatic referral pattern were observed in response to oesophageal electrical stimulation (P = 0.03). Patients with globus demonstrate oesophageal visceral hypersensitivity to mechanical distension. The differential responses to stretch and electrical stimuli may indicate that the hypersensitivity is a peripheral, rather than central, phenomenon. The aberrant referral of oesophageal sensations in response to both mechanical and electrical stimulation supports the hypothesis that referral of symptoms to the neck might be a central phenomenon.