, Volume 42, Issue 9, pp 1853-1858

Increased Esophageal Chemoreceptor Sensitivity to Acid in Patients After Successful Reversal of Barrett's Esophagus

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Abstract

When compared to patients with erosiveesophagitis, patients with Barrett's esophagus havedemonstrated reduced chemo- and mechanoreceptorsensitivity to acid infusion and balloon distension,respectively. However, anecdotal clinical experiencesuggested an increase in symptom perception in patientsafter successful elimination of Barrett's epithelium,using multipolar electrocoagulation (MPEC) and high-dose proton pump inhibitor (PPI). To determineperception thresholds to acid infusion, we evaluatedeight consecutive patients after a series of MPECtreatments resulted in complete elimination of Barrett's mucosa and compared them to 10 age-matchedpatients with nonreversed Barrett's esophagus and 10patients with symptomatic, endoscopy-documented erosiveesophagitis (Hetzel-Dent grade 2 or greater).Chemosensitivity was determined by a modified acid perfusiontest, where acid perception thresholds were quantifiedby the lag time to initial typical symptom perception,sensory intensity rating, and an acid perfusion sensory score (APSS). While patients aftersuccessful elimination of Barrett's esophagus hadsimilar sensory intensity ratings and APSS as patientswith erosive esophagitis, the lag times differedsignificantly between the groups, and both groups hadsignificantly higher sensory intensity ratings and APSSthan patients with nonreversed Barrett's esophagus. Inconclusion, patients after complete reversal ofBarrett's mucosa are unexpectedly as sensitive to acid assymptomatic patients with erosive esophagitis.