Diminished mechanosensitivity and chemosensitivity in patients with achalasia
- 1 December 2003
- journal article
- Published by American Physiological Society in American Journal of Physiology-Gastrointestinal and Liver Physiology
- Vol. 285 (6) , G1198-G1203
- https://doi.org/10.1152/ajpgi.00102.2003
Abstract
The pathogenesis of achalasia involves the degeneration of enteric and autonomic nervous systems with resultant effects on esophageal motility. The neural degeneration could affect visceral sensation in achalasia. The aim of this study was to examine mechanosensitivity and chemosensitivity in patients with achalasia. Perceptual responses to esophageal distension and acid perfusion were assessed in nine achalasia patients and nine healthy subjects. Mechanosensitivity was evaluated using a barostat with a double-random staircase distension protocol. Responses were graded as follows: 0, no sensation; 1, initial sensation; 2, mild discomfort; 3, moderate discomfort; and 4, pain. Chemosensitivity was graded along a visual analog scale after perfusion of saline and 0.1 N HCl. Barostat pressure-volume relationships were used to report esophageal body compliance. Barostat pressures for initial sensation and mild discomfort were not significantly different for patients and controls. The pressures for moderate discomfort (37.9 ± 3.5 vs. 25.7 ± 2.4 mmHg; P < 0.05) and pain (47.8 ± 2.3 vs. 32.2 ± 3.5 mmHg; P = 0.002) were significantly higher in achalasics than controls. Seven of the eight achalasia patients never reached pain thresholds at the maximum distension pressure (50 mmHg). Sensation to acid perfusion was significantly lower in achalasics compared with controls (2.2 ± 1.2 vs. 6.7 ± 1.7 cm; P < 0.05). Compliance was significantly increased in patients with achalasia compared with controls. We conclude that both mechanosensitivity and chemosensitivity are significantly diminished in achalasia patients compared with controls. Also, initial sensation and pain sensation are differentially affected in achalasics. These findings suggest that neuropathic defects in achalasia may manifest themselves in visceral sensory and motor dysfunction.Keywords
This publication has 19 references indexed in Scilit:
- Manometric heterogeneity in patients with idiopathic achalasiaGastroenterology, 2001
- IV. Visceral afferent contributions to the pathobiology of visceral painAmerican Journal of Physiology-Gastrointestinal and Liver Physiology, 2000
- Cortical Processing of Human Somatic and Visceral SensationJournal of Neuroscience, 2000
- Chest pain in achalasia: Patient characteristics and clinical courseGastroenterology, 1999
- Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humansGastroenterology, 1998
- Intraesophageal balloon distension test in Chagas' disease patients with noncardiac chest pain.Digestive Diseases and Sciences, 1998
- Oesophageal tone in patients with achalasiaGut, 1997
- Histopathologic features in esophagomyotomy specimens from patients with achalasiaGastroenterology, 1996
- The Enteric Nervous SystemNew England Journal of Medicine, 1996
- Graded esophageal balloon distentionDigestive Diseases and Sciences, 1986