title: Brain processing of visceral sensation upon esophageal chemical stimulation in different types of GERD.
abstract: We designed to investigate the cortical response to esophageal acid exposure in different types of gastroesophageal reflux disease (GERD) by functional magnetic resonance imaging (fMRI). Fifteen healthy volunteers, 13 with reflux esophagitis (RE), 12 with non-erosive reflux disease with abnormal acid reflux (NERD+) and nine with non-erosive reflux disease with normal acid reflux (NERD-) received intraesophageal perfusion with isotonic saline followed by 0.1 N hydrochloric acid. Modified block-design model of fMRI scanning was performed simultaneously to the intraesophageal perfusion. The sensitized regions in different types of GERD were not completely identical but were more widely distributed compared to the sensitized regions in the healthy individuals. The activated intensity of the ACC was significantly higher in the healthy volunteers compared to the GERD patients (P<0.001). Nevertheless, healthy volunteers exhibited a significantly lighter intensity in the right side of the DLPFC (P<0.001) and a lower intensity in the left side of the insula than the GERD patients (P<0.05). In conclusion, the underlying central mechanisms of esophageal visceral sensation in different types of GERD patients are quite different. The deactivation of the ACC, the activation of the right side of the DLPFC and the right side of the insula may play an important role in the occurrence of GERD.
authors.affiliation: Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China. xschang@163.com
authors.forename: ShuChang
authors.initials: S
authors.lastname: Xu
authors.forename: FangFang
authors.initials: F
authors.lastname: Zheng
authors.forename: XiaoHu
authors.initials: X
authors.lastname: Zhao
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.forename: Xuan
authors.initials: X
authors.lastname: Kong
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.forename: LiRen
authors.initials: L
authors.lastname: Zhu
authors.forename: ZhiYong
authors.initials: Z
authors.lastname: Wang
mesh_terms: D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D006851:Hydrochloric Acid; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017833:Visceral Afferents / Q000503:physiopathology
chemical_list: D006851:Hydrochloric Acid