title: Increased esophageal sensitivity to acid and saline in patients with nonerosive gastro-esophageal reflux disease.
abstract: OBJECTIVE
  To investigate the features of nonerosive reflux disease (NERD).
  
  
  BACKGROUND
  NERD is not considered as a milder form of erosive gastro-esophageal reflux disease (eGERD). Although the prevalence of NERD was reported to be high in our country, there have been very few studies about NERD.
  
  
  METHODS
  We performed upper gastrointestinal endoscopy to confirm the diagnosis of GERD. The modified acid perfusion test and saline perfusion test were performed in 7 control subjects, 14 NERD, and 11 eGERD patients. The stimulus-response function to acid and saline was quantified by the duration of typical symptom perception (minutes), total sensory intensity rating (0 to 10), and the perfusion sensory score (SS), which was defined as the product of minutes and the sensory intensity rating.
  
  
  RESULTS
  The mean value of SS by saline was 0 in control subjects, 12.0 in NERD patients, and 1.5 in eGERD patients (P<0.01 control vs. NERD, P<0.01 NERD vs. eGERD). The mean SS with acid was 0.9 in control subjects, 52.5 in NERD patients, and 23.0 in eGERD patients (P<0.01 control vs. NERD, control vs. eGERD, P<0.05 NERD vs. eGERD). A statistically significant association was shown between the acid and saline perfusion SSs with a correlation coefficient value of r=0.57 in the NERD group (P<0.05).
  
  
  CONCLUSIONS
  Both eGERD and NERD, but especially NERD, exhibited esophageal hypersensitivity not only to acid but also saline perfusion, suggesting that hyperalgesia to acid and other factors (eg, psychologic and/or autonomic nerve disturbance) may play some roles in symptom generation in NERD.
authors.affiliation: Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. nagahara@med.juntendo.ac.jp
authors.forename: Akihito
authors.initials: A
authors.lastname: Nagahara
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
authors.forename: Toshoku
authors.initials: T
authors.lastname: Minoo
authors.forename: Mariko
authors.initials: M
authors.lastname: Hojo
authors.forename: Masato
authors.initials: M
authors.lastname: Kawabe
authors.forename: Taro
authors.initials: T
authors.lastname: Osada
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kurosawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Asaoka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Terai
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ohkusa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000187:drug effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000139:chemically induced / Q000503:physiopathology*; D006801:Humans; D006851:Hydrochloric Acid / Q000008:administration & dosage* / Q000009:adverse effects; D006967:Hypersensitivity / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010477:Perfusion; D012684:Sensory Thresholds; D012720:Severity of Illness Index; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D012965:Sodium Chloride; D006851:Hydrochloric Acid