Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP)

In noncardiac chest pain (NCCP), altered visceral perception may result from abnormal cerebral processing of sensory input rather than abnormalities of afferent pathways. However, the interactions between symptoms, autonomic function and oesophageal stimuli are poorly studied. Oesophageal stimulatio...

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Bibliographic Details
Published in:Neurogastroenterology and motility 2000-12, Vol.12 (6), p.555-565
Main Authors: Hollerbach, S., Bulat, R., May, A., Kamath, M. V., Upton, A. R. M., Fallen, E. L., Tougas, G.
Format: Article
Language:English
Subjects:
acid reflux
Adult
Afferent Pathways - physiology
autonomic nervous system balance
Brain Stem - physiopathology
Chest Pain - physiopathology
Electric Stimulation
Electroencephalography
Esophagus - innervation
Esophagus - physiology
Evoked Potentials, Somatosensory - physiology
Female
Gastroesophageal Reflux - physiopathology
Heart Rate
Humans
Male
Middle Aged
non‐cardiac chest pain (NCCP)
Perceptual Disorders - physiopathology
Reaction Time - physiology
Reflex, Abnormal - physiology
Sensory Thresholds - physiology
sympathetic activity
Sympathetic Nervous System - physiology
vagal response
Vagus Nerve - physiology
visceral hypersensitivity
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Summary:In noncardiac chest pain (NCCP), altered visceral perception may result from abnormal cerebral processing of sensory input rather than abnormalities of afferent pathways. However, the interactions between symptoms, autonomic function and oesophageal stimuli are poorly studied. Oesophageal stimulation elicits reproducible cortical evoked potentials [CEP] and modulates heart rate variability via vagal pathways, as visible on power spectrum analysis of heart rate variability [PS‐HRV]. These methods are increasingly used to study the function of visceral afferent neural pathways in human. The aim of this study was to compare EP and PS‐HRV during oesophageal stimuli in NCCP and controls. Twelve healthy volunteers (one female, 11 male; aged 24–51 years; mean 32 ± 8 years), and eight NCCP patients (three female, five male; age range 26–58, mean 40.5 ± 10 years) were studied. Electrical oesophageal stimulation (EOS; 200 μs, 0.2 Hz, 25 stimuli) was applied to the oesophageal wall 5 cm above the lower oesophageal sphincter (LOS), and perception thresholds (measured in mA) determined. EP responses were recorded using 22 standard electroencephalogram scalp electrodes. Autonomic activity was assessed using PS‐HRV, before, during, and after oesophageal stimulation. Measured PS‐HRV indices included high frequency (HF; 0.15–0.5 Hz) and low frequency (LF; 0.06–0.15 Hz) power, respectively, assessing vagal and sympathetic activity, and the LF/HF ratio. EOS perception occurred at lower thresholds in NCCP than in controls (3.6 ± 1 vs. 7.8 ± 2 mA, P 
ISSN:1350-1925
1365-2982
DOI:10.1046/j.1365-2982.2000.00230.x