Effects of transcranial direct current stimulation on esophageal motility in patients with gastroesophageal reflux disease.
OBJECTIVE
To evaluate the effects of transcranial direct current stimulation (tDCS) on esophageal peristalsis in patients with gastroesophageal reflux disease (GERD).


METHODS
Patients with GERD preliminary diagnosis were included in a randomized double-blind sham-controlled study. Esophageal manometry was performed before and during transcranial direct current stimulation (tDCS) of the right precentral cortex. Half of patients were randomly assigned to anodal, half to sham stimulation. Distal waves amplitude and pathological waves percentage were measured, after swallowing water boli, for ten subsequent times. Last, a 24h pH-bilimetry was done to diagnose non-erosive reflux disease (NERD) or functional heartburn (FH). The values obtained before and during anodal or sham tDCS were compared.


RESULTS
Sixty-eight patients were enrolled in the study. Distal waves mean amplitude increased significantly only during anodal tDCS in NERD (p=0.00002) and FH subgroups (p=0.008) while percentage of pathological waves strongly decreased only in NERDs (p=0.002).


CONCLUSIONS
Transcranial stimulation can influence cortical control of esophageal motility and improve pathological motor pattern in NERD and FH but not in erosive reflux disease (ERD) patients.


CONCLUSIONS
Pathophysiological processes in GERD are not only due to peripheral damage but to central neural control involvement as well. In ERD patients dysfunctions of the cortico-esophageal circuit seem to be more severe and may affect central nervous system physiology.
Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy. Electronic address: simone.vigneri@unipa.it.
Simone
S
Vigneri
Department of Emergency Surgery - Digestive Motility Section, University of Palermo, Italy.
Sebastiano
S
Bonventre
Department of Emergency Surgery - Digestive Motility Section, University of Palermo, Italy.
Angela
A
Inviati
Department of Emergency Surgery - Digestive Motility Section, University of Palermo, Italy.
Domenico
D
Schifano
Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy.
Giuseppe
G
Cosentino
Santa Maria del Prato Hospital, Feltre, Italy.
Angela
A
Puma
Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy.
Giuseppe
G
Giglia
Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy.
Piera
P
Paladino
Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy.
Filippo
F
Brighina
Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy.
Brigida
B
Fierro
D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D004566:Electrodes; D015154:Esophageal Motility Disorders / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D065908:Transcranial Direct Current Stimulation
Distal amplitude; ERD; NERD; Pathological waves; Sensitization; tDCS