title: The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  Most patients with gastroesophageal reflux disease (GERD) report that stress exacerbates their symptoms, yet mechanisms underlying this association remain unknown. We sought to determine the effect of an acute laboratory stressor on perceptual and emotional responses to intraesophageal acid perfusion in healthy controls and patients with GERD.
  
  
  METHODS
  Forty-six patients with heartburn and 10 healthy controls underwent upper endoscopy and, if negative, pH monitoring. Assessment of psychologic factors and health-related quality of life was done by a questionnaire. Perceptual and emotional responses to intraesophageal acid at baseline, during auditory stress, and during an auditory control condition were determined using a randomized crossover design. Plasma levels of norepinephrine, adrenocorticotropic hormone, and cortisol were assessed.
  
  
  RESULTS
  Twenty-nine subjects were identified as nonerosive reflux disease and 17 as erosive esophagitis. Quality of life, psychologic profile, and personality assessment variables were similar among the 2 patient groups and the controls. There was a significant reduction in mean lag time to initial symptom perception and an increase in mean intensity rating and mean acid perfusion sensitivity score in the 2 patient groups during the stress period, which was not seen during the control condition. Healthy controls demonstrated lack of a significant change in all parameters of stimulus response functions to acid, regardless of condition.
  
  
  CONCLUSIONS
  Acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptual response to intraesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor.
authors.affiliation: The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, Department of Medicine, Southern Arizona VA Health Care System and Arizona Health Sciences Center, Tucson, Arizona, USA. Ronnie.Fass@va.gov
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Naliboff
authors.forename: Shira S
authors.initials: SS
authors.lastname: Fass
authors.forename: Nitzan
authors.initials: N
authors.lastname: Peleg
authors.forename: Christopher
authors.initials: C
authors.lastname: Wendel
authors.forename: Isaac B
authors.initials: IB
authors.lastname: Malagon
authors.forename: Emeran A
authors.initials: EA
authors.lastname: Mayer
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D018592:Cross-Over Studies; D004644:Emotions; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000378:metabolism / Q000473:pathology / Q000523:psychology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009622:Noise / Q000009:adverse effects*; D009638:Norepinephrine / Q000097:blood; D010465:Perception; D011788:Quality of Life; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D009638:Norepinephrine