Cerebral electrical potentials evoked by balloon distention of the human esophagus

Cerebral evoked potentials provide a technique for evaluation of central nervous processing of information derived from a variety of sensory modalities. Evoked potentials associated with balloon distention of the smooth muscle esophagus were studied in 14 adult volunteers. Stimulation was applied via repeated inflation and deflation of a balloon attached to a pressure pump that cycled at 0.2 Hz. Cortical electrical responses were recorded from scalp electrodes at Cz, Cz', and Pz of the international 10-20 System for electroencephalographic recording. The recording electrodes were referenced to Fpz and averaged over a 1-s period for 100 repetitions. Latencies, amplitudes, and waveforms of the evoked potentials were compared with controls consisting of pump on/balloon detached, auditory masking, and conventional somatosensory posterior tibial nerve stimulation. Polyphasic evoked potentials were obtained in all subjects, and maximum positive deflections occurring with latencies of 202-396 ms. Maximal amplitudes ranged from 2.5-8.3 microV. Latencies and amplitudes of the evoked responses were highly reproducible in each subject with considerable variation among subjects.

(a) Reproducible evoked potentials with distinctive waveforms can be recorded in response to esophageal balloon distention in humans; (2) long latency of the evoked potentials suggests involvement of nonmyelinated visceral afferent pathways; (3) the evoked potentials are probably specific to mechanical stimulation rather than being nonspecific arousal responses; and (4) the results support this as a promising new method for investigation of the neurobiology of gastrointestinal sensation in humans that may help clarify pathological conditions of the irritable esophagus syndrome and esophagus-related chest pain.