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Effect of acid swallowing on esophageal contraction in patients with heartburn related to hypersensitivity

Authors
 Hyuk Lee  ;  Sang Kil Lee  ;  Jun Chul Park  ;  Sung Kwan Shin  ;  Yong Chan Lee 
Citation
 JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol.28(1) : 84-89, 2013 
Journal Title
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
ISSN
 0815-9319 
Issue Date
2013
MeSH
Acids*/pharmacology ; Adult ; Area Under Curve ; Esophageal Diseases/diagnosis* ; Esophageal Diseases/pathology ; Esophageal Diseases/physiopathology ; Esophageal pH Monitoring ; Esophagoscopes ; Esophagus/drug effects* ; Esophagus/pathology ; Esophagus/physiopathology ; Female ; Fruit ; Gastroesophageal Reflux/diagnosis ; Heartburn/diagnosis* ; Heartburn/physiopathology ; Humans ; Male ; Manometry*/methods ; Middle Aged ; Muscle Contraction/drug effects* ; Muscle, Smooth/physiology ; Peristalsis ; Plant Preparations*/pharmacology ; Pressure ; Punicaceae ; ROC Curve ; Statistics, Nonparametric ; Water/pharmacology
Keywords
esophageal hypersensitivity ; functionalheartburn ; high resolution manometry
Abstract
BACKGROUND AND AIM:
There are heterogeneous subgroups among those with heartburn, and data on these individuals are relatively scant. We aimed to evaluate the effect of acid challenge on the segmental contractions of esophageal smooth muscle in endoscopy-negative patients with normal esophageal acid exposure.
METHODS:
High-resolution esophageal manometry (HRM) was performed on 30 endoscopy-negative patients with heartburn accompanied by normal esophageal acid exposure using 10 water swallows followed by 10 acidic pomegranate juice swallows. Patients were classified into functional heartburn (FH) and hypersensitive esophagus (HE) groups based on the results of 24-hr impedance pH testing. HRM topographic plots were analyzed and maximal wave amplitude and pressure volumes were measured for proximal and distal smooth muscle segments.
RESULTS:
The pressure volume of the distal smooth muscle segment in the HE group measured during acidic swallows was higher than during water swallows (2224.1 ± 68.2 mmHg/cm per s versus 2105.6 ± 66.4 mmHg/cm per s, P = 0.027). A prominent shift in the pressure volume to the distal smooth muscle segment was observed in the HE group compared with the FH group (segmental ratio: 2.72 ± 0.08 versus 2.39 ± 0.07, P = 0.005). Manometric measurements during acidic swallows revealed that this shift was augmented in the HE group. The optimal ratio of pomegranate juice swallowing for discrimination of FH from HE was 2.82, with a sensitivity of 88.9% and a specificity of 100%.
CONCLUSIONS:
Hypercontractile response of distal smooth muscle segment to acid swallowing was more prominent in the HE group than the FH group.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2012.07258.x/abstract
DOI
10.1111/j.1440-1746.2012.07258.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86244
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