Browsing by Subject "heartburn"

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    Esophageal acid stimulation alters insular cortex functional connectivity in gastroesophageal reflux disease
    (Wiley, 2015-02) Siwiec, R. M.; Babaei, A.; Kern, M.; Samuel, E. A.; Li, S.-J.; Shaker, R.; Department of Medicine, IU School of Medicine
    BACKGROUND: The insula plays a significant role in the interoceptive processing of visceral stimuli. We have previously shown that gastroesophageal reflux disease (GERD) patients have increased insular cortex activity during esophageal stimulation, suggesting a sensitized esophago-cortical neuraxis. However, information regarding the functional connectivity (FC) of the insula during visceral stimulation is lacking. The primary aim of this study was to investigate the FC of insular subregions during esophageal acid stimulation. METHODS: Functional imaging data were obtained from 12 GERD patients and 14 healthy subjects during four steady state conditions: (i) presence of transnasal esophageal catheter (pre-infusion); (ii) neutral solution; (iii) acid infusion; (iv) presence of transnasal esophageal catheter following infusions (post-infusion). The insula was parcellated into six regions of interest. FC maps between each insular ROI and interoceptive regions were created. Differences in FC between GERD patients and healthy subjects were determined across the 4 study conditions. KEY RESULTS: All GERD patients experienced heartburn during and after esophageal acidification. Significant differences between GERD patients and healthy subjects were seen in: (i) insula-thalamic FC (neutral solution infusion, acid infusion, post-infusion); (ii) insula-amygdala FC (acid infusion, post-infusion); (iii) insula-hippocampus and insula-cingulate FC (post-infusion). CONCLUSIONS & INFERENCES: Esophageal stimulation in GERD patients revealed significant insular cortex FC differences with regions involved in viscerosensation and interoception. The results of our study provide further evidence that the insula, located at the transition of afferent physiologic information to human feelings, is essential for both visceral homeostasis and the experience of heartburn in GERD patients.
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    Symptom association for gastroesophageal reflux disease by PH monitoring after peroral endoscopic myotomy: GERD and symptoms after POEM
    (Wolters Kluwer, 2022-04) DeWitt, John; Kessler, William; Wo, John; Stainko, Sarah; Perkins, Anthony; Dickason, Destenee; Al-Haddad, Mohammad; Siwiec, Robert; Biostatistics, School of Public Health
    Introduction: There are limited data correlating symptoms with reflux episodes during pH studies after POEM. Methods: Consecutive patients who underwent POEM followed ≥6 months later by 48-hour ambulatory wireless pH testing off antisecretory therapy were identified. Reflux symptom association (RSA) was defined as SAP >95%. Results: The most frequent of symptoms of heartburn (47.2%), cough (45.1%) and chest pain (39.6%) were associated with a positive RSA (SAP >95%) in 20.9%, 17.1% and 19.4%, respectively. Discussion: There is poor correlation between reported symptoms and esophageal acid exposure during pH testing after POEM.