J Neurogastroenterol Motil.  2013 Oct;19(4):503-508.

Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults

• Ohara S
• Furuta K
• Adachi K
• Fukazawa K
• Aimi M
• Miki M
• Kinoshita

Abstract

BACKGROUND/AIMS
The sensitivity of the upper and lower esophageal mucosa to acid is considered to differ. We investigated the relationship between pH changes in different sites of the esophagus and generation of gastroesophageal reflux symptoms during an acid infusion test.
METHODS
An acid infusion catheter was placed at 5 or 15 cm above the lower esophageal sphincter (LES) in 18 healthy volunteers, while a 2-channel pH sensor catheter was also placed in each with the sensors set at 5 and 15 cm above the LES. Solutions containing water and hydrochloric acid at different concentrations were infused through the infusion catheter.
RESULTS
Acid infusion in the upper esophagus caused a pH drop in both upper and lower esophageal sites, whereas that in the lower esophagus resulted in a significant pH drop only in the lower without a corresponding pH decline in the upper esophagus. Stronger heartburn, chest pain, and chest oppression symptoms were noted when acid was infused in the upper as compared to the lower esophagus, while increased intra-esophageal acidity strengthened each symptom. Regurgitations caused by upper and lower esophageal acid infusions were similar, and not worsened by a larger drop in intra-esophageal pH. Chest pain was caused only by lowered intra-esophageal pH, while heartburn, chest oppression, and regurgitation were induced by a less acidic solution.
CONCLUSIONS
Higher intra-esophageal acidity caused stronger heartburn, chest pain, and chest oppression symptoms. However, regurgitation was not significantly influenced by intra-esophageal acidity. The upper esophagus showed higher acid sensitivity than the lower esophagus.

Keyword

Heartburn; Esophagus; Gastroesophageal reflux

MeSH Terms

Adult
Catheters
Chest Pain
Esophageal pH Monitoring*
Esophageal Sphincter, Lower
Esophagus
Gastroesophageal Reflux*
Heartburn
Humans
Hydrochloric Acid
Hydrogen-Ion Concentration
Mucous Membrane
Thorax
Water
Hydrochloric Acid
Water