2005 Abstracts: Role of Calcitonin Gene Related Peptide in Esophageal Hypersensitivity of Non-Erosive Reflux Disease
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Role of Calcitonin Gene Related Peptide in Esophageal Hypersensitivity of Non-Erosive Reflux Disease
Zhaoshen Li, Xiaorong Xu, Duowu Zou, Min Yang, Guoming Xu, Yanfang Gong, Xiaohua Man, Jianping Lu, Changhai Hospital , Second Military Medical University, Shanghai, Shanghai, China
OBJECTIVE: More than half the patients with gastroesophageal reflux disease (GERD) show no endoscopic abnormality now termed non-erosive reflux disease(NERD). The aim of this study was to evaluate and to characterize the role of visceral hypersensitivity in the pathogenesis of NERD.
METHODS: Subjects with symptoms such as heartburn and acid regurgitations of 3 months duration underwent endoscopic and those with endoscopically visible signs of esophagitis (Los Angeles A¨CD) or Barrett¡¯s esophagus were excluded. The esophageal specimens from endoscopic normality patients (N 26) were immune-histologically evaluated for calcitonin gene related peptide (CGRP)-stain positive neural fibers and cells. Esophageal manometry, Bernstein testing, intraesophageal balloon distention (IEBD), and 24-h esophageal pH monitoring were underwent in these patients. 10 controls were enrolled in this study. RESULTS: Normal acid contact time (pH>4) was observed in 52% of these NERD subjects. 85% developed heartburn during Bernstein acid infusion, Initial perception threshold and maximally tolerated pain threshold of NERD patients was 9.6¡À4.8 ml and 12.3¡À3.2ml,significantly decreased than thoses of control,13.2¡À7.5 ml and 21.6¡À5.7 ml , respectively.(P<0.007, P<0.003) . The mean optical density (OD) value of CGRP-positive contents in NERD and control subjects were 0.43¡À0.12 and 0.23¡À0.10,repectively(P< 0.02) ,the number of CGRP-positive neural fibers (4.48¡À1.92) observed in NERD patients¡¯esopheageal mucosa was significantly increased than that of the control( 2.44¡À1.21), (P< 0.03). The mean OD value of NERD subjects was negativelyrelated with the initial perception threshold and maximally tolerated pain threshold,r values were - 0.927 and- 0.748,£¨P<0.007£©. CONCLUSIONS: Our results suggest that a significant lower threshold for esophageal sensation and pain in NERD , the pathogenesis of typical heartburn symptoms may associated with visceral hypersensitivity to mechanical or chemical stimuli. CGRP may be involved in processing of the esophageal hypersensitivity at least in the primary afferents level.
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