Reduced chemoreceptor sensitivity in patients with Barrett's esophagus may be related to age and not to the presence of Barrett's epithelium.
BACKGROUND
Patients with Barrett's esophagus have demonstrated reduced chemo- and mechanoreceptor sensitivity to acid infusion and balloon distension, respectively. However, Barrett's esophagus is mainly a disease of the elderly, making age the possible underlying mechanism for altered pain perception in this patient population.


OBJECTIVE
To determine perception thresholds to acid infusion in elderly (>65 yr) versus younger (< or =50 yr) patients with Barrett's esophagus.


METHODS
Twelve elderly and 10 younger patients, matched by length of Barrett's mucosa, were recruited into the study. All patients participated in our Barrett's esophagus surveillance program. The patients were treated with omeprazole 20 to 60 mg/day and were symptom free. Chemosensitivity was determined by a modified acid perfusion test, in which acid perception thresholds were quantified by the lag time to initial typical symptom perception, sensory intensity rating, and an acid perfusion sensory score.


RESULTS
Five of the elderly patients with Barrett's esophagus had a negative test, whereas all younger patients with Barrett's esophagus experienced typical symptom perception during acid infusion. Elderly patients with Barrett's esophagus had significantly longer lag time to initial perception, lower acid perfusion sensory score, and sensory intensity rating in comparison with the younger patients.


CONCLUSIONS
Reduced chemoreceptor sensitivity to acid perfusion that has previously been demonstrated in patients with Barrett's esophagus may be related to age and not to the presence of Barrett's epithelium.
Grade
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Department of Medicine, Tucson VA Medical Center 85723, USA.
Pulliam
G
G
Johnson
C
C
Garewal
H
H
Sampliner
R E
RE
Fass
R
R
D000328:Adult; D000368:Aged; D000375:Aging / Q000187:drug effects*; D001471:Barrett Esophagus / Q000175:diagnosis*; D002628:Chemoreceptor Cells / Q000187:drug effects*; D004848:Epithelium / Q000187:drug effects; D004947:Esophagus / Q000187:drug effects; D005500:Follow-Up Studies; D006801:Humans; D006851:Hydrochloric Acid; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012684:Sensory Thresholds / Q000187:drug effects
D006851:Hydrochloric Acid