Esophageal sensitivity and visceral pain perception in health is not modulated by endogenous opioid release
Notice bibliographique
Résumé
ISDE VANCOUVER 2014 Abstract 669 "Esophageal sensitivity and visceral pain perception in health is not modulated by endogenous opioid release" Background:When gastro-esophageal reflux is causing symptoms (heartburn, regurgitation) or lesions (esophagitis), it is defined as gastro-esophageal reflux disease (GERD). A large group of patients does not present with esophageal lesions and are referred to as non-erosive reflux disease patients (NERD). Proton pump inhibitors (PPI) are effective in healing esophagitis, but a large group of NERD patients remains symptomatic while taking PPIs. In these patients, esophageal hypersensitivity is considered an important pathophysiological mechanism and this is often linked to defective functioning of descending anti-nociceptive pathways, although evidence to support this hypothesis is lacking. Endogenous opioids are key candidate mediators of descending anti-nociception. Our aim was to study the role of centrally acting and peripherally restricted µ-opioid receptor antagonists naloxone and methylnaltrexone respectively on esophageal sensitivity in healthy volunteers (HV). Methods:Esophageal multimodal sensitivity was quantified after administration of naloxone (20µg/kg/h IV infusion after 0.4mg bolus), methylnaltrexone (12mg/0.6ml SC injection) and placebo (0.9% NaCl) in 12 HV (7m/5f, mean age 31 y [range 22-51]). After an overnight fast, a custom made probe with a balloon was positioned in the distal esophagus. Thermal (recirculating a heated solution through the balloon), mechanical (increasing balloon volume), electrical (2 stimulation electrodes) and chemical sensitivity (modified Bernstein) were tested. Perception scores were evaluated on Visual Analogue Scales (VAS). Stimulus intensities were evaluated for first perception (VAS 1), pain perception threshold (VAS 5) and pain toleration threshold (VAS 7). General mood was assessed by the Positive and Negative Affect Schedule (PANAS) and the State-Trait Anxiety Inventory (STAI-state) questionnaires before and after the stimulations. Results were analyzed using repeated measures ANOVA or the non-parametric Kruskal-Wallis test. P-values of <0.05 were considered significant. Results:Both naloxone and methylnaltrexone had no significant influence on esophageal sensitivity compared to placebo conditions. First perception, VAS 5 and VAS 7 thresholds did not differ when comparing naloxone or methylnaltrexone with placebo conditions during all stimulations. There was no difference for PANAS and STAI-State questionnaires before and after the stimulations for the different sessions. Discussion:To our knowledge, this is the first study to address the role of endogenous opioids in determining esophageal sensitivity in health. We found no evidence of a tonic inhibitory effect of endogenous opioid pathways on esophageal sensitivity in health. The mechanisms of esophageal visceral pain perception are independent of endogenous opioid release.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».