LOWERED ESOPHAGEAL SENSORY THRESHOLDS IN PATIENTS WITH SYMPTOMATIC BUT NOT EXCESS GASTROESOPHAGEAL REFLUX - EVIDENCE FOR A SPECTRUM OF VISCERAL SENSITIVITY IN GORD

Some patients undergoing ambulatory oesophageal pH monitoring to inves tigate symptoms suggestive of gastro-oesophageal reflux disease (GORD) are found to have oesophageal acid exposure within the physiological range but show a close correlation between their symptoms and individu al reflux episodes. It is suggested that these patients might exhibit enhanced oesophageal sensation, akin to the heightened perception of b oth physiological and provocative stimuli in the gut that has been des cribed in patients with functional gastrointestinal disorders. This st udy tested the hypothesis by measuring the sensory thresholds for oeso phageal balloon distension and discomfort in 20 patients with symptoms of GORD, in whom ambulatory pH monitoring had shown normal acid expos ure times, but in whom the symptom index for reflux events was 50% or greater, and compared these with 15 healthy volunteer controls, and wi th control groups with confirmed excess reflux. The study group showed lower thresholds both for initial perception of oesophageal distensio n, and for discomfort, compared with healthy controls (median ml (rang e)); 7.5 (2-19) upsilon 12 (6-30) (p = 0.002) and 10 (5-20) upsilon 16 (8-30) (p < 0.0001), respectively. Sensory thresholds in the study gr oup were also significantly lower than in patients with excess reflux, and than patients with Barrett's oesophagus, who also exhibited signi ficantly higher sensory thresholds than healthy controls. No differenc es in sensory thresholds for somatic nerve stimulation were found betw een the study group and healthy controls. The results show a spectrum of visceral sensitivity in GORD, with enhanced oesophageal sensation i n patients with symptomatic but not excess gastro-oesophageal reflux, suggesting that their symptoms result from a heightened perception of normal reflux events.