Duodenal fat intensifies the perception of heartburn

• Published in: Gut Vol. 49; no. 5; pp. 624 - 628
• Main Authors: Meyer, J H, Lembo, A, Elashoff, J D, Fass, R, Mayer, E A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.11.2001; BMJ; BMJ Publishing Group LTD
• Subjects: Acidification; Adult; Aged; Analysis of Variance; Anti-Ulcer Agents - therapeutic use; Biological and medical sciences; Cardiovascular disease; Dietary Fats - administration & dosage; Digestive system; Dose-Response Relationship, Drug; Duodenum; Endoscopy; fat; Female; gastro-oesophageal reflux disease; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - physiopathology; Gastrointestinal Contents - chemistry; heartburn; Heartburn - drug therapy; Heartburn - etiology; Heartburn - physiopathology; Humans; Hydrochloric Acid - administration & dosage; Hydrogen-Ion Concentration; Investigative techniques, diagnostic techniques (general aspects); Load; Male; Meals; Medical sciences; Middle Aged; Omeprazole - therapeutic use; Pain; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Perception; Perceptions; Physiology; Statistics, Nonparametric; Burn; Human; Gastroesophageal reflux; Statistical analysis; Duodenum; Volunteer; Esophageal disease; Fat; Digestive diseases; Intensification; Perception; Severity score
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.49.5.624

BACKGROUND Patients with gastro-oesophageal reflux disease (GORD) frequently report that meals high in fat worsen heartburn. Nevertheless, studies to determine whether high fat meals promote gastro-oesophageal reflux have produced conflicting and equivocal conclusions. PATIENTS AND METHODS To determine, alternatively, whether fat in the small intestinal lumen intensifies the perception of heartburn, we studied 11 patients with typical heartburn from GORD. After being placed on omeprazole to suppress endogenous acid, these fasting subjects underwent oesophageal perfusions with graded doses of HCl at pH values of 1.0, 1.5, 2.0, and 2.5. Oesophageal perfusions were conducted while the duodenum was perfused with saline (control) and again with fat at 8 g/h. RESULTS Time to onset, intensity, and severity of heartburn varied with dose of oesophageal acid (p<0.01). Time to onset was significantly (p<0.01) shorter, and intensity and severity of heartburn significantly (p<0.05) greater, during duodenal perfusion with fat. CONCLUSION We conclude that duodenal fat intensifies the perception of heartburn.