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Gut. 2006 Jul;55(7):926-32. Epub 2005 Aug 9.

Multimodal pain stimulations in patients with grade B oesophagitis.

Author information

  • 1Centre for Visceral Biomechanics and Pain, Department of Medical Gastroenterology, Aalborg Hospital, DK-9100, and Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Denmark. drewes@smi.auc.dk

Abstract

AIM:

To obtain a better understanding of nociceptive processing in patients with oesophagitis.

PATIENTS AND METHODS:

Eleven patients with grade B oesophagitis were compared with an age and sex matched group of 16 healthy subjects. A probe was positioned in the lower part of the oesophagus. After preconditioning of the tissue, painful mechanical stimuli were applied as distensions with a bag using an impedance planimetric method. Distensions were done before and after pharmacological impairment of distension induced smooth muscle contractions. Thermal stimulation was performed by recirculating water at 1 and 60 degrees C in the bag. The area under the temperature curve (AUC) represented caloric load. The referred pain area (being a proxy for the central pain mechanisms) to the mechanical stimuli was drawn at maximum pain intensities.

RESULTS:

Patients were hyposensitive to mechanical stimuli, as assessed by the distending volume (F=8.1, p=0.005). After relaxation of smooth muscle with butylscopolamine, the difference between the two groups was more evident (F=27.4, p<0.001). AUC for cold stimulation was 1048.6 (242.7) degrees Cxs in controls and 889.8 (202.6) degrees Cxs in patients (p=0.5). For heat stimuli, AUC values were 323.3 (104.1) and 81.3 (32.3) degrees Cxs in controls and patients, respectively (p=0.04). The referred pain area to the mechanical stimulations was larger and more widespread in patients (49.3 (6.2) cm2 compared with controls 23.9 (7) cm2; p=0.02).

CONCLUSIONS:

The data indicate that peripheral sensitisation of heat sensitive receptors and pathways combined with facilitation of central pain mechanisms may explain the symptoms in patients with oesophagitis.

PMID:
16091554
[PubMed - indexed for MEDLINE]
PMCID:
PMC1856350
Free PMC Article
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