title: The effects of proton pump inhibitors on autonomic tone in patients with erosive and non-erosive esophagitis.
abstract: Reduction in autonomic tone as measured by heart rate variability (HRV) has been associated with various inflammatory conditions including reflux disease. The nature of and permanence of this damage have not been fully assessed.
  
  
  
  Fourteen individuals with non-erosive reflux disease (NERD) and 10 individuals with erosive reflux disease (ERD) as identified on endoscopy were assessed for HRV prior to starting a course of proton pump inhibitor (PPI) therapy and 8 weeks from the start of PPI therapy.
  
  
  
  Reflux symptoms were significantly improved by PPI therapy (p = 0.001), with no significant difference in reflux symptoms between the NERD and ERD groups either before (p = 0.45) or following therapy (p = 0.17). The ERD group displayed reduced HRV prior to PPI therapy as compared with a non-symptomatic group. There was significant improvement of HRV resulting from PPI therapy in the ERD group as measured by inspiration/expiration ratio on forced breathing (p = 0.02), Valsalva ratio (p = 0.03), and extended metronome-guided breathing at 6 breaths per minute (p = 0.03). While a similar pattern was seen in the NERD group, the effects were not as strong and did not reach statistical significance.
  
  
  
  The results are consistent with a growing body of evidence that cardiac autonomic neuropathy as measured by HRV is associated with gastro-esophageal reflux disease and also suggest that successful treatment of the inflammation can lead to reversal of the deterioration of autonomic tone associated with that inflammation.
authors.affiliation: Medical Physics Department, Poole Hospital NHS Foundation Trust, Poole, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Jones
authors.affiliation: Medical Physics Department, Poole Hospital NHS Foundation Trust, Poole, UK.
authors.forename: S
authors.initials: S
authors.lastname: Perring
authors.affiliation: Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khattab
authors.affiliation: Department of Surgery, Poole Hospital NHS Foundation trust, Poole, UK.
authors.forename: O
authors.initials: O
authors.lastname: Allenby-Smith
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000187:drug effects / Q000502:physiology; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors
keywords: autonomic function; esophagitis; gastro-esophageal reflux disease; heart rate variability; proton pump inhibitor