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Visceral Symptoms and Dilated Intercellular Spaces in a Rat Chronic Acid Reflux Esophagitis Model Are Mediated by Increased Neuropeptides Expression in Dorsal Root Ganglion

2011; Elsevier BV; Volume: 140; Issue: 5 Linguagem: Inglês

10.1016/s0016-5085(11)62581-x

1528-0012

Tadayuki Oshima, Junichi Koseki, Tomohisa Hattori, Yoshio Kase, Takashi Kondo, Jun Sakùrai, Hirokazu Fukui, Jiro Watari, Takayuki Matsumoto, Hiroto Miwa,

Helicobacter pylori-related gastroenterology studies

BACKGROUND AND AIM: Most mucosal complications of gastroesophageal reflux disease (GERD) occur very close to the esophagogastric junction (EGJ).Recently, a post-prandial acid pocket in the proximal stomach has been described with a film of acid extending across the EGJ.This is particularly evident in GERD patients postprandially, when heartburn is most common [1].Alginates are thought to work by creating a low density polymer "raft" that floats on top of gastric contents imparting a physical separation from the esophageal mucosa.We hypothesized that the post-prandial acid pocket can be displaced by an alginateantacid formulation in GERD patients.METHODS: 10 GERD patients (5M, ages 27-46, GERDQ score 9-14, no hiatal hernia), off acid-suppressive medications for at least one week prior, were studied.Acid pocket measurements were made using concurrent station pH catheter pull-throughs (0.5 cm increments every 10s), high resolution manometry (Sierra), and fluoroscopy in a semi-recumbent (~30 o ) posture.Each subject underwent three acid pocket measurements: fasted, 20 min after consuming a high-fat meal (McDonald's® Double Quarter Pounder with Cheese, small serving of fries; 970 kcal), and 20 min after a 20ml oral dose of Gaviscon Double Action Liquid® (alginate, calcium carbonate, and sodium bicarbonate; Reckitt Benckiser Healthcare (UK) Ltd) administered post-prandial.The relative positions of pH transition point (pH > 4) and margins of esophagogastric junction (EGJ) high-pressure zone were analyzed.Values are shown as median (5-95 th percentile).RESULTS: Most patients (8) exhibited an unbuffered acidified segment extending from the proximal stomach into the EGJ HPZ when fasted that persisted postprandially (Figure).Gaviscon neutralized the acidified segment, eliminating the acid pocket and acid film in 6 of the 8 subjects that this was evident post-prandial with the pH transition point significantly shifted away from the EGJ (p=0.02).The length of EGJ high-pressure zone was unaltered (fasting 2.9 (2.6-3.6)cm vs. postprandial 2.8 (2.4-3.4)cm vs. post-Gaviscon 2.9 (2.1-3.3)cm, p=0.8) throughout the study.Postprandial decrease of EGJ pressure was minimal (fasting 7 (0.5 -21) mmHg vs. postprandial 2 (0-10) mmHg vs. post-Gaviscon 4 (0-15) mmHg, p= 0.05).CONCLUSION: Gaviscon Double Action Liquid® can eliminate the acid pocket and neutralize the post-prandial film of acidity within the EGJ in GERD patients.Considering that EGJ length was unchanged throughout, this effect was likely attributable to the alginate raft displacing gastric contents away from the EGJ.These findings suggest Gaviscon Double Action Liquid® to be a well-targeted postprandial GERD therapy.