Development of esophageal hypersensitivity following experimental duodenal acidification

Anthony R. Hobson, Radia W. Khan, Sanchoy Sarkar, Paul L. Furlong, Qasim Aziz

    Research output: Contribution to journalArticlepeer-review

    Abstract

    OBJECTIVES: As visceral afferents from different regions of the gastrointestinal tract converge at the level of the spinal cord, we hypothesized that sensitization of one gut organ would induce visceral hypersensitivity in another gut organ, remote to the sensitizing stimulus. METHODS: Protocol 1: Eight healthy male volunteers, age 30 ± 8.2 yr, underwent three studies on different days. Esophageal pain thresholds (PT) were recorded at 10-min intervals prior to and for 2 h following a 30-min duodenal infusion of either 0.15 M hydrochloric acid (HCI), saline, or no infusion. Five subjects repeated the study to demonstrate reproducibility. Protocol 2: Esophageal evoked potentials (EEP) were studied in six subjects on two occasions prior to and 1 h after a 30-min duodenal infusion of 0.15 M HCI or saline. RESULTS: Protocol 1: After acid infusion, there were reproducible reductions in esophageal PT (ICC = 0.88), which were maximal at 110 min (15.05 ± 2.25 mA) (p <0.002). Following saline infusion there was an increase in esophageal PT (ICC = 0.71), which was similar to the no-infusion condition (6.21 ± 1.54 mA vs 8.5 + 7.6 mA; p > 0.05). Protocol 2: Esophageal sensation scores increased (p = 0.02) after acid, but not after saline infusion (p = 0.1). A comparison of the latencies of EEP components prior to and following acid and saline infusion revealed a reduction in the N1 (p = 0.02) and P2 components (p = 0.04). CONCLUSION: This study provides the first objective evidence that duodenal acidification can induce esophageal hypersensitivity associated with changes in sensitivity of the central visceral pain pathway. As the esophagus was remote from the sensitizing stimulus, central sensitization of spinal dorsal horn neurons is likely to have contributed to these changes.
    Original languageEnglish
    Pages (from-to)813-820
    Number of pages7
    JournalAmerican Journal Of Gastroenterology
    Volume99
    Issue number5
    DOIs
    Publication statusPublished - May 2004

    Keywords

    • Adult
    • Comparative Study
    • drug effects: Duodenum
    • drug effects: Esophagus
    • Gastric Acid
    • Human
    • pharmacology: Hydrochloric Acid
    • Hydrogen-Ion Concentration
    • chemically induced: Hyperesthesia
    • drug effects: Intestinal Secretions
    • Male
    • Middle Aged
    • Pain Measurement
    • drug effects: Pain Threshold
    • Reference Values
    • Sensitivity and Specificity
    • Support, Non-U.S. Gov't

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