Intraesophageal acid perfusion sensitizes the esophagus to mechanical distension: a Barostat study
Intraesophageal acid perfusion sensitizes the esophagus to mechanical distension: a Barostat study
复制标题
DOI：
10.1111/j.1572-0241.2000.02236.x
复制
发表时间：
2000-09
影响因子：
9.8
通讯作者：
W. Hu;Christopher J. Martin;N. Talley
中科院分区：
文献类型：
--
作者：
W. Hu;Christopher J. Martin;N. Talley
目的：非心源性胸痛的发病机制尚不清楚。在一部分这样的患者中，已经证明了胃食管反流增加和食管内球囊扩张的疼痛阈值降低。我们的目的是调查是否酸暴露敏感食管mechanoreceptors在健康volunteers.METHODS：经过一夜的快速，无限顺应性的气球，4.5厘米长，安装在多腔经鼻测压导管，被放置在8.5厘米以上的下食管括约肌在12名健康男性志愿者，年龄在18-39岁。在确定最小膨胀压力后，通过计算机控制的恒压器（G & J Electronics，Canada）将球囊膨胀至48 mm Hg。分级逐步扩张穿插随机降低压力到以前的值的三分之二。在每个压力水平下，受试者被要求报告感觉和疼痛的存在。重复基线扩张以确定压力/容量关系的再现性以及感知和疼痛阈值。基线扩张序列后，食管灌注20分钟（在7毫升/分钟）与生理盐水（对照）或0.1 N盐酸在37°C的随机basis.Results：基础感觉阈值变化很大（第一感觉5-36毫米汞柱，疼痛8 ≥ 43毫米汞柱）。两名受试者在达到最大扩张压力（校正最小扩张压力后，分别为42和43 mm Hg）时未出现疼痛。重复扩张时食管体顺应性相似。感觉阈值是可重复的不同的扩张（感知r = 0.99，疼痛r = 0.95）。生理盐水没有导致感知或疼痛阈值的显著变化。酸灌注降低了第一感觉（酸前和酸后的中位数分别为15 mm Hg和8 mm Hg，p = 0.05）和疼痛阈值（酸前和酸后的中位数分别为32.5 mm Hg和26.5 mm Hg，p = 0.05）。与生理盐水灌注后的变化相比，酸灌注降低了感知阈值（中位数变化，−3.8 mm Hg vs 0 mm Hg，p = 0.04），并倾向于降低疼痛阈值（中位数变化，−3.75 mm Hg vs+0.75 mm Hg，p = 0.09）。结论：使用恒压器进行食管内球囊扩张是测量食管体顺应性和感觉阈值的可重复方法。急性酸暴露似乎使食管对腔内球囊扩张的感知敏感。
OBJECTIVE:The pathogenesis of noncardiac chest pain is unclear. Increased gastroesophageal reflux and decreased pain thresholds to intraesophageal balloon distension have been demonstrated in a proportion of such patients. We aimed to investigate whether acid exposure sensitizes esophageal mechanoreceptors in healthy volunteers.METHODS:After an overnight fast, an infinitely compliant balloon, 4.5 cm in length and mounted on a multilumen transnasal manometry catheter, was placed 8.5 cm above the lower esophageal sphincter in 12 healthy male volunteers aged 18–39 yr. After determination of the minimal distending pressure, the balloon was inflated up to 48 mm Hg by means of a computer-controlled barostat (G & J Electronics, Canada). Graded stepwise distensions were interspersed with random decreases in pressure to two-thirds of the previous value. At each pressure level, the subjects were asked to report on sensation and the presence of pain. Baseline distension was repeated to determine reproducibility of the pressure/volume relationship and also the perception and pain thresholds. After the baseline distension sequence, the esophagus was perfused for 20 min (at 7 ml/min) with either normal saline (control) or 0.1 N hydrochloric acid at 37°C on a random basis.RESULTS:Basal sensory thresholds varied widely (first perception 5–36 mm Hg, pain 8 ≥ 43 mm Hg). Two subjects did not experience pain up to the maximum distending pressure (42 and 43 mm Hg, respectively, after correction for the minimal distending pressure). Esophageal body compliance was similar on repeat distension. Sensory thresholds were reproducible with different distensions (perception r = 0.99, pain r = 0.95). Saline resulted in no significant changes in perception or pain thresholds. Acid perfusion reduced first perception (median before and after acid, 15 mm Hg and 8 mm Hg, respectively, p = 0.05) and pain threshold (median before and after acid, 32.5 mm Hg and 26.5 mm Hg, respectively, p = 0.05). When compared to changes after saline perfusion, acid perfusion reduced the perception threshold (median change, −3.8 mm Hg vs 0 mm Hg, p = 0.04) and tended to reduce the pain threshold (median change, −3.75 mm Hg vs+0.75 mm Hg, p = 0.09).CONCLUSIONS:Intraesophageal balloon distension using a barostat is a reproducible method of measuring esophageal body compliance and sensory thresholds. Acute exposure to acid seems to sensitize the esophagus to perception from intraluminal balloon distension.