Digestive Diseases and Sciences

, Volume 58, Issue 7, pp 1955–1959

Effect of Amiloride on Experimental Acid-Induced Heartburn in Non-erosive Reflux Disease

  • William J. Bulsiewicz
  • Nicholas J. Shaheen
  • Mark B. Hansen
  • Amy Pruitt
  • Roy C. Orlando
Original Article

Abstract

Background

Acid-sensing ion channels (ASICs) are esophageal nociceptors that are candidates to mediate heartburn in non-erosive reflux disease (NERD). Amiloride, a diuretic, is known to inhibit ASICs. For this reason, we sought a role for ASICs in mediating heartburn by determining whether amiloride could block heartburn in NERD induced by esophageal acid perfusion.

Methods

In a randomized double-blind crossover study, we perfused the esophagus with amiloride or (saline) placebo prior to eliciting acid-induced heartburn in patients with a history of proton pump inhibitor-responsive NERD. Those with NERD and positive modified Bernstein test were randomized to perfusion with amiloride, 1 mmol/l, or placebo for 5 min, followed by repeat acid-perfusion. Heartburn severity and time to onset was measured and the process repeated following crossover to the alternative agent.

Results

14 subjects completed the study. Amiloride did not reduce the frequency (100 vs. 100 %) or severity of acid-induced heartburn (Mean 2.50 ± SEM 0.33 vs. 2.64 ± 0.45), respectively. There was a trend towards longer time to onset of heartburn for amiloride versus placebo (Mean 2.93 ± SEM 0.3 vs. 2.36 ± 0.29 min, respectively), though these differences did not reach statistical significance (p > 0.05).

Conclusions

Amiloride had no significant effect on acid-induced heartburn frequency or severity in NERD, although there was a trend towards prolonged time to onset of symptoms.

Keywords

Non-erosive reflux disease (NERD) Acid-sensing ion channels (ASICs) Amiloride Modified Bernstein test 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • William J. Bulsiewicz
    • 1
  • Nicholas J. Shaheen
    • 1
  • Mark B. Hansen
    • 2
  • Amy Pruitt
    • 1
  • Roy C. Orlando
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing Center for Gastrointestinal Biology and DiseaseUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.AstraZeneca R&DMölndalSweden

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