Document Detail


In vivo evaluation of acid-induced changes in oesophageal mucosa integrity and sensitivity in non-erosive reflux disease.
MedLine Citation:
PMID:  22722617     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Patients with non-erosive reflux disease (NERD) have impaired oesophageal mucosal integrity (dilated intercellular spaces). Oesophageal mucosal integrity reflects the balance between repeated reflux damage and mucosal recovery. The relationship between mucosal integrity and acid sensitivity is unclear. Oesophageal impedance may be used for in vivo mucosal integrity measurement. We studied acid-induced changes in oesophageal mucosal integrity and acid perception in patients with heartburn.
DESIGN: 50 patients with heartburn whithout oesophagitis underwent impedance monitoring before, during and after 10 min oesophageal perfusion with neutral (pH 6.5) and acid solutions (pH 1). Symptoms and impedance were recorded during perfusion. Impedance recovery was assessed for 2 h post-perfusion in ambulatory conditions followed by 24-h impedance-pH study.
RESULTS: Reflux monitoring discriminated 20 NERD and 30 functional heartburn (FH) patients. Neutral perfusion caused impedance fall that recovered within 10 min. Acid perfusion caused impedance fall with slow recovery: 6.5 Ω/min (IQR 3.3-12.0 Ω/min). Patients with slow recovery (< 25th percentile) had lower baseline impedance (1273 Ω ± 208 Ω vs. 3220 Ω ± 275 Ω ±, p < 0.01) and more frequent acid sensitivity (10/12 vs. 4/12, p = 0.04) than those with fast (> 75th percentile) recovery. Patients with NERD had lower baseline impedance (1669 ± 182 Ω vs. 2384 ± 211 Ω, p = 0.02) and slower impedance recovery (6.0 ± 0.9 Ω/min vs. 10.7 ± 1.6 Ω/min, p = 0.03) than patients with FH.
CONCLUSION: Impaired mucosal integrity might be the consequence of repeated reflux episodes with slow recovery. Mucosal integrity, recovery capacity and symptom perception are linked. Low basal impedance and slow recovery after acid challenge are associated with increased acid sensitivity.
Authors:
Philip Woodland; Mohannad Al-Zinaty; Etsuro Yazaki; Daniel Sifrim
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-06-21
Journal Detail:
Title:  Gut     Volume:  62     ISSN:  1468-3288     ISO Abbreviation:  Gut     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-08-06     Completed Date:  2013-12-31     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  1256-61     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acids / pharmacology*
Electric Impedance*
Esophageal pH Monitoring
Esophagus* / pathology,  physiopathology
Extracellular Space
Female
Gastroesophageal Reflux* / complications,  diagnosis,  physiopathology
Heartburn / diagnosis,  etiology*,  physiopathology
Humans
Hydrogen-Ion Concentration
Male
Middle Aged
Mucous Membrane / physiopathology*
Recovery of Function
Severity of Illness Index
Symptom Assessment / methods
Time Factors
Grant Support
ID/Acronym/Agency:
G0802313//Medical Research Council; MGAB1A7R//Medical Research Council
Chemical
Reg. No./Substance:
0/Acids
Comments/Corrections
Comment In:
Gut. 2014 Feb;63(2):368   [PMID:  24048735 ]

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


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