Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 10045-10052
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.10045
Influence of capsaicin infusion on secondary peristalsis in patients with gastroesophageal reflux disease
Chih-Hsun Yi, Wei-Yi Lei, Jui-Sheng Hung, Tso-Tsai Liu, Chien-Lin Chen, Fabio Pace
Chih-Hsun Yi, Wei-Yi Lei, Jui-Sheng Hung, Tso-Tsai Liu, Chien-Lin Chen, Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97002, Taiwan
Fabio Pace, Division of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, 20157 Milano, Italy
Author contributions: Yi CH and Chen CL contributed to study concept and design, analysis and interpretation of data, drafting of the manuscript, and statistical analysis; Lei WY, Hung JS and Liu TT contributed to the acquisition of data and research performance; Pace F contributed to the improvement of the manuscript; all authors have approved the final version of the manuscript.
Institutional review board statement: This study was performed after approval by Research Ethics Committee of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chien-Lin Chen MD, PhD, Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien 97002, Taiwan. harry.clchen@msa.hinet.net
Telephone: +886-3-8561825 Fax: +886-3-8577161
Received: July 7, 2016
Peer-review started: July 11, 2016
First decision: September 5, 2016
Revised: September 20, 2016
Accepted: November 12, 2016
Article in press: November 13, 2016
Published online: December 7, 2016
Processing time: 152 Days and 0.1 Hours
Abstract
AIM

To determine whether capsaicin infusion could influence heartburn perception and secondary peristalsis in patients with gastroesophageal reflux disease (GERD).

METHODS

Secondary peristalsis was performed with slow and rapid mid-esophageal injections of air in 10 patients with GERD. In a first protocol, saline and capsaicin-containing red pepper sauce infusions were randomly performed, whereas 2 consecutive sessions of capsaicin-containing red pepper sauce infusions were performed in a second protocol. Tested solutions including 5 mL of red pepper sauce diluted with 15 mL of saline and 20 mL of 0.9% saline were infused into the mid-esophagus via the manometric catheter at a rate of 10 mL/min with a randomized and double-blind fashion. During each study protocol, perception of heartburn, threshold volumes and peristaltic parameters for secondary peristalsis were analyzed and compared between different stimuli.

RESULTS

Infusion of capsaicin significantly increased heartburn perception in patients with GERD (P < 0.001), whereas repeated capsaicin infusion significantly reduced heartburn perception (P = 0.003). Acute capsaicin infusion decreased threshold volume of secondary peristalsis (P = 0.001) and increased its frequency (P = 0.01) during rapid air injection. The prevalence of GERD patients with successive secondary peristalsis during slow air injection significantly increased after capsaicin infusion (P = 0.001). Repeated capsaicin infusion increased threshold volume of secondary peristalsis (P = 0.002) and reduced the frequency of secondary peristalsis (P = 0.02) during rapid air injection.

CONCLUSION

Acute esophageal exposure to capsaicin enhances heartburn sensation and promotes secondary peristalsis in gastroesophageal reflux disease, but repetitive capsaicin infusion reverses these effects.

Keywords: Capsaicin; Esophageal motility; Secondary peristalsis; Esophageal manometry; Gastroesophageal reflux disease

Core tip: This clinical significance of this study is that acute esophageal infusion of capsaicin-containing red pepper sauce significantly enhances mechanosensitivity to distension-induced secondary peristalsis in patients with gastroesophageal reflux disease (GERD), which might be beneficial in reflux patient with hypomotility. Conversely, repeated esophageal exposure to capsaicin-containing red pepper sauce may reduce the efficiency of esophageal secondary peristalsis. Repeated capsaicin infusion may therefore reduce the protection of the esophagus by hampering the clearing of residue substance or refluxate in the esophagus, which may in turn prolong acid clearance in patients with GERD.