Esophageal sensitivity and symptom perception in gastroesophageal reflux disease

Patients with gastroesophageal reflux disease (GERD) experience a wide spectrum of symptoms, varying both in quality and severity. This review summarizes clinical observations of esophageal sensitivity and symptom perception in GERD patients. The Bernstein test, although lacking standardization, rem...

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Bibliographic Details
Published in:Current gastroenterology reports 1999-06, Vol.1 (3), p.214-219
Main Authors: Shi, G, Tatum, R P, Joehl, R J, Kahrilas, P J
Format: Article
Language:English
Subjects:
Acids
Chest Pain - diagnosis
Chest Pain - etiology
Diagnosis, Differential
Esophagitis, Peptic - diagnosis
Esophagitis, Peptic - physiopathology
Esophagus
Esophagus - innervation
Gastroesophageal reflux
Humans
Manometry
Mechanoreceptors - physiopathology
Monitoring, Ambulatory
Nociceptors - physiopathology
Pain Threshold - physiology
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Summary:Patients with gastroesophageal reflux disease (GERD) experience a wide spectrum of symptoms, varying both in quality and severity. This review summarizes clinical observations of esophageal sensitivity and symptom perception in GERD patients. The Bernstein test, although lacking standardization, remains a useful tool in determining esophageal sensitivity to acid stimuli. Ambulatory 24-hour pH monitoring with symptom event marking and subsequent symptom-reflux correlation between acid reflux events and esophageal symptomatology now provides an alternative method for establishing esophageal acid sensitivity. The intraesophageal balloon distention test (IEBD) was developed to assess esophageal sensitivity to mechanical stimuli. Variants of each of these tests have been applied to the evaluation of uncomplicated GERD patients and patients with esophagitis and Barrett's metaplasia, who generally demonstrate less esophageal sensitivity than the former group. Studies using these methods have demonstrated increased esophageal sensitivity in patients with esophageal chest pain and have also identified a subset of patients with esophageal symptoms yet normal esophageal acid exposure, a condition referred to as "hypersensitive esophagus." The Bernstein test, 24-hour pH monitoring with symptom assessment, and IEBD have each contributed to our understanding of esophageal pain syndromes; it is hoped that future work in this area will lead to improved and more specific therapy for these patients.
ISSN:1522-8037
1534-312X
DOI:10.1007/s11894-999-0037-z