The effect of antireflux treatment on patients with gastroesophageal reflux disease undergoing a mental arithmetic stressor

Neurogastroenterol Motil. 2011 Nov;23(11):e489-96. doi: 10.1111/j.1365-2982.2011.01691.x. Epub 2011 Mar 2.


Background: Acute stress exacerbates heartburn in gastroesophageal reflux disease (GERD) patients by enhancing the perceptual responses to intraesophageal acid. The aim of the study was to determine if antireflux treatment can still alter stimulus response functions to acid in patients undergoing acute stress as compared with placebo.

Methods: Symptomatic GERD patients with erosive esophagitis (EE) or an abnormal pH test were included. Patients underwent stimulus response functions to intraesophageal acid perfusion using the mental arithmetic stressor test. Thereafter, patients were randomized (2 : 1 ratio) to either esomeprazole 40 mg once daily or placebo for 8 weeks. On the last day of treatment, subjects underwent stimulus response functions to intraesophageal acid perfusion using a similar stressor as baseline.

Key results: A total of 31 patients were randomized into the treatment arm (mean age 48.6 ± 2.8, M/F 21/10) and 16 into the placebo arm (mean age 52.3 ± 4.3, M/F 12/4). In the esomeprazole group, there was a significant increase in lag time to symptom perception (P = 0.02) and decreased in intensity rating (P = 0.01) as well as acid perfusion sensitivity score (P = 0.01). There was no significant difference in any of the stimulus response functions to acid in the placebo group between baseline and treatment. Interpersonal sensitivity was the only independent clinical predictor factor for response to antireflux treatment.

Conclusions & inferences: Long-term antireflux treatment with a proton pump inhibitor is effective in reducing esophageal perception responses to acid during acute stress.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Ulcer Agents / therapeutic use*
  • Esomeprazole / therapeutic use*
  • Esophageal pH Monitoring
  • Esophagus / pathology
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / physiopathology*
  • Gastroesophageal Reflux / psychology*
  • Humans
  • Hydrochloric Acid / administration & dosage
  • Placebos / therapeutic use
  • Quality of Life
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires


  • Anti-Ulcer Agents
  • Placebos
  • Esomeprazole
  • Hydrochloric Acid