The symptoms of gastroesophageal reflux disease (GERD)are of two major types.Typical GERD symptoms are mainly heartburns or acid regurgitation while atypical GERD symptoms may involve a vari-ety of organ systems,including respiratory,ENT,and cardiovascular symptoms.The underlying mechanisms for the differing major symptom manifestations remain unknown.This study was aimed to compare esophageal sensi-tivity to balloon distension and acid infusion between the both major groups.We hypothesized that visceral percep-tion in each group was different.
Material and Method:
The diagnosis of GERD was based on an ambulatory pH monitoring for all study patients.Perceptual responses to esophageal balloon distension and intraluminal acid perfusion were evalu-ated in 9 typical GERD patients and in 7 atypical GERD patients.Mechanosensitivity was evaluated with a barostat sing unbiased distension protocols and verbal ratings of sensations (no sensation,moderate sensation,discomfort, and pain).Chemosensitivity to acid was determined by employing the visual analogue scale and the acid perfusion intensity score.
Typical GERD patients showed a higher volume threshold of esophageal discomfort percep-tion in response to phasic distension than atypical GERD patients (26.66 ±7.91 ml VS.18.75 ±4.40 ml,p <0.05). The perception score in response to acid perfusion in both groups was similar.
Atypical GERD patients had lower threshold for esophageal discomfort in response to balloon distension compared to typical GERD cases,whereas the sensation thresholds in response to acid perfusion into the esophagus were not different.
[Thai J Gastroenterol 2008;9(1):12-18.]