Kern M K, Birn R M, Jaradeh S, Jesmanowicz A, Cox R W, Hyde J S, Shaker R
Medical College of Wisconsin, Medical College of Wisconsin, Dysphagia Institute, Milwaukee, Wisconsin, USA.
Gastroenterology. 1998 Dec;115(6):1353-62. doi: 10.1016/s0016-5085(98)70013-7.
BACKGROUND & AIMS: Esophageal acid exposure is a common occurrence in healthy individuals and patients with esophagitis. Clinically, perception of this exposure ranges from no perception to severe heartburn and chest pain. Cerebral cortical response to esophageal mucosal contact to acid has not been systematically studied. The aim of this study was to elucidate cerebral cortical response to esophageal acid exposure in normal individuals by functional magnetic resonance imaging (FMRI).
We studied 10 normal healthy volunteers. Cortical FMRI response to 10 minutes of intraesophageal perfusion of 0.1N HCl (1 mL/min) was determined, and the results were compared with those of saline infusion and balloon distention.
Acid perfusion did not induce heartburn or chest pain but increased FMRI signal intensity by 6.7% +/- 2.0% over the preperfusion values. No increase was detected for saline infusion. FMRI signal intensity to balloon distention was similar to that of acid perfusion. Activation latency, activation to peak, and the deactivation periods for response to acid perfusion were significantly longer than those of balloon distention (P < 0.05).
Contact of esophageal mucosa with acid, before inducing heartburn, evokes a cerebral cortical response detectable by FMRI. Temporal characteristics of this response are significantly different from those induced by esophageal balloon distention.
食管酸暴露在健康个体和食管炎患者中都很常见。临床上，对这种暴露的感知程度从无感知到严重烧心和胸痛不等。大脑皮质对食管黏膜接触酸的反应尚未得到系统研究。本研究的目的是通过功能磁共振成像（FMRI）阐明正常个体对食管酸暴露的大脑皮质反应。
我们研究了10名正常健康志愿者。测定了皮质FMRI对10分钟食管内灌注0.1N盐酸（1毫升/分钟）的反应，并将结果与盐水灌注和球囊扩张的结果进行比较。
酸灌注未诱发烧心或胸痛，但FMRI信号强度比灌注前值增加了6.7%±2.0%。盐水灌注未检测到增加。球囊扩张的FMRI信号强度与酸灌注相似。酸灌注反应的激活潜伏期、激活至峰值以及失活期均明显长于球囊扩张（P<0.05）。
食管黏膜与酸接触在诱发烧心之前，会引发可通过FMRI检测到的大脑皮质反应。这种反应的时间特征与食管球囊扩张诱发的反应明显不同。
