Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
World J Gastroenterol. 2010 Nov 21;16(43):5481-9. doi: 10.3748/wjg.v16.i43.5481.
To investigate symptoms and brain activity following esophageal acid infusion.
Fifteen healthy volunteers were recruited for the study. Hydrochloric acid (pH 1 and 2) and distilled water (pH 7) were randomly and repeatedly infused into the esophagus. The brain activity was evaluated by positron emission tomography. The severity of heartburn elicited by the infusion was rated on an auditory analog scale of 0-10.
The severity of heartburn following each infusion showed a step-wise increase with increasing acidity of the perfusate. The heartburn scores were significantly higher in the second pH 1 infusion compared with the first infusion. Acid and distilled water infusion induced activation of various brain areas such as the anterior insula, temporal gyrus, and anterior/posterior cingulate cortex. At pH 1 or 2, in particular, activation was observed in some emotion-related brain areas such as the more anterior part of the anterior cingulate cortex, parahippocampal gyrus, or the temporal pole. Strong activation of the orbitofrontal cortex was found by subtraction analysis of the two second pH 1 infusions, with a significant increase of heartburn symptoms.
Emotion-related brain areas were activated by esophageal acid stimulation. The orbitofrontal area might be involved in symptom processing, with esophageal sensitization induced by repeated acid stimulation.
研究食管酸灌注后的症状和大脑活动。
招募了 15 名健康志愿者参与研究。将盐酸（pH 值为 1 和 2）和蒸馏水（pH 值为 7）随机重复灌注到食管中。通过正电子发射断层扫描评估大脑活动。通过 0-10 的听觉模拟量表对灌注引起的烧心严重程度进行评分。
每次灌注后烧心的严重程度随灌注液酸度的增加呈阶梯式增加。第二次 pH 值为 1 的灌注引起的烧心评分明显高于第一次灌注。酸和蒸馏水灌注诱导了各种大脑区域的激活，如前岛叶、颞叶和前/后扣带回皮质。在 pH 值为 1 或 2 时，特别是在前扣带皮质的更前部、海马旁回或颞极等一些与情绪相关的大脑区域观察到激活。通过两次第二次 pH 值为 1 的灌注的减法分析发现眶额皮质强烈激活，同时烧心症状显著增加。
食管酸刺激激活了与情绪相关的大脑区域。眶额区域可能参与症状处理，重复酸刺激引起食管敏化。
