Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Curr Opin Gastroenterol. 2021 Jul 1;37(4):372-377. doi: 10.1097/MOG.0000000000000749.
Despite the wide prevalence of gastro-esophageal reflux disease (GERD), the neurophysiological mechanisms underlying heartburn perception in the esophagus of patients with GERD remains incompletely understood. Recent studies have highlighted the potential influence sensory afferent nerves innervating the oesophageal epithelium may have on heartburn pathogenesis. The purpose of this review is to consider the current understanding of esophageal afferent neuronal innervation, including the nociceptive role of acid-sensing receptors expressed on these sensory nerves, in relation to pain perception in the esophagus of GERD patients.
Central and peripheral pathways of sensitization following noxious stimulation of nociceptive receptors expressed on afferent nerves can regulate the strength of sensory nerve activation in the esophagus, which can result in the amplification or suppression of afferent signal transmission. The localization and characterization of mucosal sensory afferent nerves vary between GERD phenotypes and may explain the heterogeneity of symptom perception in patients with apparently similar levels of reflux.
In this review, we discuss the relevance of afferent esophageal innervation in heartburn perception, with a particular focus on the pathways of reflux-induced activation of nociceptive nerves.
尽管胃食管反流病（GERD）广泛流行，但 GERD 患者食管烧心感的神经生理机制仍不完全清楚。最近的研究强调了支配食管上皮的感觉传入神经可能对烧心发病机制的潜在影响。本文的目的是考虑目前对食管传入神经元支配的理解，包括酸敏感受体在这些感觉神经上的痛觉作用，与 GERD 患者食管疼痛感知的关系。
伤害感受器受体受有害刺激后的中枢和外周致敏途径可调节食管感觉神经激活的强度，从而导致传入信号转导的放大或抑制。GERD 表型之间黏膜感觉传入神经的定位和特征不同，可能解释了症状感知在反流程度相似的患者中存在异质性的原因。
在这篇综述中，我们讨论了传入性食管支配在烧心感中的相关性，特别关注了反流引起的伤害性神经激活途径。
