Increased esophageal sensitivity to acid and saline in patients with nonerosive gastro-esophageal reflux disease.
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.
Nagahara
Akihito
A
Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. nagahara@med.juntendo.ac.jp
Miwa
Hiroto
H
Minoo
Toshoku
T
Hojo
Mariko
M
Kawabe
Masato
M
Osada
Taro
T
Kurosawa
Akihiko
A
Asaoka
Daisuke
D
Terai
Takeshi
T
Ohkusa
Toshifumi
T
Sato
Nobuhiro
N
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
D012965:Sodium Chloride; D006851:Hydrochloric Acid