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The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease.
Gastroenterology 2008; 134(3):696-705G

Abstract

BACKGROUND & AIMS

Most patients with gastroesophageal reflux disease (GERD) report that stress exacerbates their symptoms, yet mechanisms underlying this association remain unknown. We sought to determine the effect of an acute laboratory stressor on perceptual and emotional responses to intraesophageal acid perfusion in healthy controls and patients with GERD.

METHODS

Forty-six patients with heartburn and 10 healthy controls underwent upper endoscopy and, if negative, pH monitoring. Assessment of psychologic factors and health-related quality of life was done by a questionnaire. Perceptual and emotional responses to intraesophageal acid at baseline, during auditory stress, and during an auditory control condition were determined using a randomized crossover design. Plasma levels of norepinephrine, adrenocorticotropic hormone, and cortisol were assessed.

RESULTS

Twenty-nine subjects were identified as nonerosive reflux disease and 17 as erosive esophagitis. Quality of life, psychologic profile, and personality assessment variables were similar among the 2 patient groups and the controls. There was a significant reduction in mean lag time to initial symptom perception and an increase in mean intensity rating and mean acid perfusion sensitivity score in the 2 patient groups during the stress period, which was not seen during the control condition. Healthy controls demonstrated lack of a significant change in all parameters of stimulus response functions to acid, regardless of condition.

CONCLUSIONS

Acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptual response to intraesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor.

Authors+Show Affiliations

The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, Department of Medicine, Southern Arizona VA Health Care System and Arizona Health Sciences Center, Tucson, Arizona, USA. Ronnie.Fass@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18206149

Citation

Fass, Ronnie, et al. "The Effect of Auditory Stress On Perception of Intraesophageal Acid in Patients With Gastroesophageal Reflux Disease." Gastroenterology, vol. 134, no. 3, 2008, pp. 696-705.
Fass R, Naliboff BD, Fass SS, et al. The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. Gastroenterology. 2008;134(3):696-705.
Fass, R., Naliboff, B. D., Fass, S. S., Peleg, N., Wendel, C., Malagon, I. B., & Mayer, E. A. (2008). The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. Gastroenterology, 134(3), pp. 696-705. doi:10.1053/j.gastro.2007.12.010.
Fass R, et al. The Effect of Auditory Stress On Perception of Intraesophageal Acid in Patients With Gastroesophageal Reflux Disease. Gastroenterology. 2008;134(3):696-705. PubMed PMID: 18206149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. AU - Fass,Ronnie, AU - Naliboff,Bruce D, AU - Fass,Shira S, AU - Peleg,Nitzan, AU - Wendel,Christopher, AU - Malagon,Isaac B, AU - Mayer,Emeran A, Y1 - 2007/12/07/ PY - 2007/08/01/received PY - 2007/11/21/accepted PY - 2008/1/22/pubmed PY - 2008/3/21/medline PY - 2008/1/22/entrez SP - 696 EP - 705 JF - Gastroenterology JO - Gastroenterology VL - 134 IS - 3 N2 - BACKGROUND & AIMS: Most patients with gastroesophageal reflux disease (GERD) report that stress exacerbates their symptoms, yet mechanisms underlying this association remain unknown. We sought to determine the effect of an acute laboratory stressor on perceptual and emotional responses to intraesophageal acid perfusion in healthy controls and patients with GERD. METHODS: Forty-six patients with heartburn and 10 healthy controls underwent upper endoscopy and, if negative, pH monitoring. Assessment of psychologic factors and health-related quality of life was done by a questionnaire. Perceptual and emotional responses to intraesophageal acid at baseline, during auditory stress, and during an auditory control condition were determined using a randomized crossover design. Plasma levels of norepinephrine, adrenocorticotropic hormone, and cortisol were assessed. RESULTS: Twenty-nine subjects were identified as nonerosive reflux disease and 17 as erosive esophagitis. Quality of life, psychologic profile, and personality assessment variables were similar among the 2 patient groups and the controls. There was a significant reduction in mean lag time to initial symptom perception and an increase in mean intensity rating and mean acid perfusion sensitivity score in the 2 patient groups during the stress period, which was not seen during the control condition. Healthy controls demonstrated lack of a significant change in all parameters of stimulus response functions to acid, regardless of condition. CONCLUSIONS: Acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptual response to intraesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/18206149/The_effect_of_auditory_stress_on_perception_of_intraesophageal_acid_in_patients_with_gastroesophageal_reflux_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(07)02171-3 DB - PRIME DP - Unbound Medicine ER -