title: Proximal and distal esophageal sensitivity is decreased in patients with Barrett's esophagus.
abstract: OBJECTIVE
  To investigate sensations to multimodal pain stimulation in the metaplastic and normal parts of the esophagus in patients with Barrett's esophagus (BE).
  
  
  METHODS
  Fifteen patients with BE and 15 age-matched healthy volunteers were subjected to mechanical, thermal and electrical pain stimuli of the esophagus. Both the metaplastic part and the normal part (4 and 14 cm, respectively, above the esophago-gastric junction) were examined. At sensory thresholds the stimulation intensity, referred pain areas, and evoked brain potentials were recorded.
  
  
  RESULTS
  Patients were hyposensitive to heat stimulation both in the metaplastic part [median stimulation time to reach the pain detection threshold: 15 (12-34) s vs 14 (6-23) s in controls; F = 4.5, P = 0.04] and the normal part of the esophagus [median 17 (6-32) s vs 13 (8-20) s in controls; F = 6.2, P = 0.02]. Furthermore, patients were hyposensitive in the metaplastic part of the esophagus to mechanical distension [median volume at moderate pain: 50 (20-50) mL vs 33 (13-50) mL in controls; F = 5.7, P = 0.02]. No indication of central nervous system abnormalities was present, as responses were comparable between groups to electrical pain stimuli in the metaplastic part [median current evoking moderate pain: 13 (6-26) mA vs 12 (9-24) mA in controls; F = 0.1, P = 0.7], and in the normal part of the esophagus [median current evoking moderate pain: 9 (6-16) mA, vs 11 (5-11) mA in controls; F = 3.4, P = 0.07]. Furthermore, no differences were seen for the referred pain areas (P-values all > 0.3) or latencies and amplitudes for the evoked brain potentials (P-values all > 0.1).
  
  
  CONCLUSIONS
  Patients with BE are hyposensitive both in the metaplastic and normal part of esophagus likely as a result of abnormalities affecting peripheral nerve pathways.
authors.affiliation: Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Krarup
authors.forename: Søren S
authors.initials: SS
authors.lastname: Olesen
authors.forename: Peter
authors.initials: P
authors.lastname: Funch-Jensen
authors.forename: Hans
authors.initials: H
authors.lastname: Gregersen
authors.forename: Asbjørn M
authors.initials: AM
authors.lastname: Drewes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000503:physiopathology*; D004569:Electroencephalography; D004947:Esophagus / Q000033:anatomy & histology / Q000294:innervation / Q000473:pathology / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D010525:Peripheral Nerves / Q000502:physiology / Q000503:physiopathology; D012684:Sensory Thresholds / Q000502:physiology; D013314:Stress, Mechanical; D013696:Temperature; D055815:Young Adult