Heart rate variability in patients with different manifestations of gastroesophageal reflux disease.
BACKGROUND
Autonomic nervous dysfunction has frequently been observed in patients with gastroesophageal reflux diseases (GERD) and impacts the pathogenesis of GERD. However, the characteristics that distinguish between GERD patients with different manifestations remain unknown.


OBJECTIVE
To investigate the autonomic nervous function in subgroups of GERD patients.


METHODS
Of the 164 participants in this study, 57 were healthy controls, 34 had non-erosive reflux disease (NERD), 40 had symptomatic esophagitis (SE), and 33 asymptomatic esophagitis (AE).


METHODS
Resting autonomic activity was assessed by measuring the 5-min heart rate variability (HRV) and HRV indices including time-domain parameters (standard deviation of normal-to-normal intervals [SDNN] and root mean square of successive differences [RMSSD]) and frequency-domain parameters (low-frequency power [LF; 0.04-0.15 Hz], high-frequency power [HF; 0.15-0.4 Hz], and LF/HF power ratio). Mental stress was assessed by use of a self-reported questionnaire (Brief Symptom Rating Scale [BSRS]).


RESULTS
HF power was (ANOVA, p=0.041) but time-domain parameters, LF power, LF/HF power ratio, and BSRS parameters were not significantly different between the four groups. A higher HF power was found in examinees with NERD than in those with SE and AE (LSD methods: both p=0.02). When split into two groups (erosive vs. non-erosive), nearly all measures of autonomic tonus were significantly lower in the erosive than non-erosive group. Age and the presence of endoscopic esophagitis influenced the RMSSD and HF power results in the regression analysis. Mental stress or gender did not correlate with any HRV index.


CONCLUSIONS
In comparison with NERD subjects, autonomic tonus in patients with endoscopically confirmed esophagitis (even without symptom) is lower. This finding may suggest that the structural state of esophagus but not symptomatology dictates autonomic function status.
Lee
Yi-Chia
YC
Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, Taiwan.
Wang
Hsiu-Po
HP
Lin
Lian-Yu
LY
Lee
Bai-Chin
BC
Chiu
Han-Mo
HM
Wu
Ming-Shiang
MS
Chen
Ming-Fong
MF
Lin
Jaw-Town
JT
D000328:Adult; D000704:Analysis of Variance; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000150:complications*; D001794:Blood Pressure / Q000502:physiology; D010054:Brief Psychiatric Rating Scale; D003710:Demography; D019723:Endoscopes; D005260:Female; D005764:Gastroesophageal Reflux / Q000145:classification / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000209:etiology; D013997:Time Factors