Document Detail

The autonomic response to human esophageal acidification and the development of hyperalgesia.
MedLine Citation:
PMID:  22672237     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Distal esophageal acidification induces variable hyperalgesia in the non-acid exposed proximal esophagus. As the autonomic nervous system (ANS) modulates nociception, the aim was to determine whether autonomic reactivity to acid infusion predicted inter-individual differences in hyperalgesia.
METHODS: In 25 healthy volunteers (18 women, age range 22-58, mean 36.5 years), using a double-blind, placebo-controlled crossover design, pain thresholds to electrical stimulation were determined in the proximal esophagus and foot (control) pre and post a 30-min distal esophageal infusion of 0.15 mol L(-1) HCl or saline with autonomic monitoring. Sympathetic Cardiac Sympathetic Index and Skin Conductance Response and parasympathetic Cardiac Vagal Tone and Cardiac Sensitivity to Baroreflex measures were derived. Plasma cortisol was measured pre and post infusion as were anxiety and unpleasantness.
KEY RESULTS: Acid infusion reduced group pain threshold in the proximal esophagus (adjusted mean change -5.0 mA vs saline +3.4 mA, P < 0.001), and raised sympathetic measures (Cardiac Sympathetic Index, Skin Conduction Response) and cortisol levels, but reduced parasympathetic measures (cardiac vagal tone and cardiac sensitivity to Baroreflex) (all P < 0.05). Acid infusion also increased anxiety and unpleasantness scores (both P < 0.05). In 16 acid-sensitizers, the degree of hyperalgesia correlated with increasing heart rate (r = -0.66, P = 0.005), and fall in cardiac vagal tone (r = 0.54, P = 0.03) and Cardiac Sensitivity to Baroreflex (r = 0.54, P = 0.03).
CONCLUSIONS & INFERENCES: Acid-induced esophageal hyperalgesia correlated with reduced parasympathetic tone, suggesting that the parasympathetic nervous system may have anti hyperalgesic properties. Additional studies on the autonomic modulation of esophageal hyperalgesia are required.
A Sharma; P Paine; S Rhodes; F Warburton; Y C Chua; Q Aziz
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-06-04
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  24     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-19     Completed Date:  2012-11-19     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  e285-93     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
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MeSH Terms
Autonomic Nervous System / drug effects,  physiopathology*
Cross-Over Studies
Double-Blind Method
Electric Stimulation
Esophagus / drug effects,  physiopathology*
Hydrochloric Acid / toxicity*
Hydrogen-Ion Concentration
Hyperalgesia / chemically induced,  physiopathology*
Middle Aged
Pain Threshold / drug effects,  physiology
Young Adult
Grant Support
G0701706//Medical Research Council; //Cancer Research UK; //Medical Research Council
Reg. No./Substance:
QTT17582CB/Hydrochloric Acid

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

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