title: Oesophageal sensation in response to high PCO(2)  and acidic solutions in nonerosive reflux disease.
abstract: BACKGROUND
  Heartburn is commonly associated with the presence of acid in the oesophageal lumen. However, in patients with nonerosive reflux disease (NERD), the mechanism by which acid traverses the mucosa is not clear. We hypothesized that the luminal acid signal traverses the oesophageal epithelium in the form of the highly permeant gas CO(2) , which then is reconverted to H(+) in the submucosa.
  
  
  METHODS
  Ten patients with heartburn, normal upper endoscopy and increased oesophageal acid exposure (NERD patients) and 10 healthy subjects were enrolled. Perceptual responses to intraoesophageal acid (0·1 N HCl solution) and a high PCO(2) solution were determined using a randomized cross over design. Stimulus-response functions to perfusions were quantified by three parameters: lag time to symptom perception, intensity rating and perfusion sensitivity score.
  
  
  RESULTS
  In NERD patients, the difference in lag time to typical symptom perception, intensity rating and perfusion sensitivity score between high PCO(2) and acid perfusions was statistically significant (P = 0·02, 0·01 and 0·02, respectively). However, the difference in the same perfusion parameters between acid and high PCO(2) perfusions was nonsignificant in healthy controls. When NERD and controls were compared, the difference between the different perfusion variables was nonsignificant (adjusted to age).
  
  
  CONCLUSIONS
  In NERD subjects, acid perfusion reliably evoked heartburn symptoms of greater intensity than in healthy controls. Nevertheless, a high PCO(2) perfusion failed to produce symptoms in either group.
authors.affiliation: The Neuroenteric Clinical Research Group, Section of Gastroenterology, Southern Arizona VA Health Care System, Tucson, AZ, USA.
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Hershcovici
authors.forename: Choo H
authors.initials: CH
authors.lastname: Poh
authors.forename: Ofer Z
authors.initials: OZ
authors.lastname: Fass
authors.forename: Nicole
authors.initials: N
authors.lastname: Ashpole
authors.forename: Yasutada
authors.initials: Y
authors.lastname: Akiba
authors.forename: Jose M
authors.initials: JM
authors.lastname: Guillén-Rodríguez
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kaunitz
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000494:pharmacology*; D016022:Case-Control Studies; D018592:Cross-Over Studies; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000187:drug effects*; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000139:chemically induced / Q000503:physiopathology; D006356:Heartburn / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D006851:Hydrochloric Acid / Q000494:pharmacology; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012684:Sensory Thresholds; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide; D006851:Hydrochloric Acid