Document Detail

Characterization of the cerebral cortical representation of heartburn in GERD patients.
MedLine Citation:
PMID:  14512287     Owner:  NLM     Status:  MEDLINE    
Although symptoms arising from the esophagus such as heartburn and pain can at times become challenging clinical problems, esophageal viscerosensation, especially with regard to chemical stimulation in humans, is incompletely understood. Our aims were 1) to characterize and ascertain the reproducibility of cerebral cortical registration of heartburn and 2) to elucidate the differences between these findings and those of esophageal subliminal acid stimulation in asymptomatic controls. We studied 11 gastroesophageal reflux disease (GERD) patients (9 males, 30-55 yr) and 15 healthy controls (8 males, 21-49 yr). Cerebral cortical functional magnetic resonance imaging (fMRI) activity was recorded twice in each subject, during two 5-min intervals of 0.1 N HCl, separated by 5 min of NaCl perfusion. Time from onset of acid perfusion to instant of fMRI signal increase and first report of heartburn averaged 1.60 +/- 0.80 and 1.85 +/- 0.60 min, respectively. Average maximum percent signal increase in the GERD patients (16.3 +/- 3.5%) was significantly greater than that of healthy controls (3.8 +/- 0.9%; P < 0.01). Temporal fMRI signal characteristics during heartburn were significantly different from those of subliminal acid stimulation in controls (P < 0.01). Activated cortical regions included sensory/motor, parieto-occipital, cingulate and prefrontal regions, and the insula. There was 92% concordance between the activated Brodmann areas in repeated studies of GERD patients. Cortical activity associated with perceived and unperceived esophageal acid exposure in GERD patients and healthy controls, respectively, involves multiple brain regions but occurs more rapidly and with greater intensity in GERD patients than the activity in response to subliminal acid exposure in healthy controls. The cortical pain-processing pathway seems to be involved in perception of esophageal acid exposure and could explain the variations encountered in clinical practice defining this sensation.
Mark Kern; Candy Hofmann; James Hyde; Reza Shaker
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2003-09-25
Journal Detail:
Title:  American journal of physiology. Gastrointestinal and liver physiology     Volume:  286     ISSN:  0193-1857     ISO Abbreviation:  Am. J. Physiol. Gastrointest. Liver Physiol.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2003-12-10     Completed Date:  2004-02-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  100901227     Medline TA:  Am J Physiol Gastrointest Liver Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  G174-81     Citation Subset:  IM    
Medical College of Wisconsin Dysphagia Institute, Division of Gastroenterology and Hepatology, Digestive Disease Center, Biophysics Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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MeSH Terms
Cerebral Cortex / physiopathology*
Functional Laterality / physiology
Gastric Acid / secretion
Gastroesophageal Reflux / physiopathology*
Heartburn / physiopathology*
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Middle Aged
Movement / physiology
Reproducibility of Results
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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