Reduced sensitivity to intra-oesophageal acid in patients with reflux-induced strictures

Patients presenting with benign reflux-induced oesophageal strictures often have no antecedent symptoms of reflux, which might be a consequence of decreased oesophageal sensitivity. This has been investigated in 36 patients with strictures and 30 patients with uncomplicated oesophagitis by means of a visual analogue scale (0 to 10) to assess preceding symptoms and acid perfusion tests to assess oesophageal sensitivity. Patients with strictures had lower symptom scores (median, 2.7) than those with uncomplicated oesophagitis (median, 4.85) and were more likely to have a negative acid perfusion test (18 of 28 compared with 6 of 23, respectively; p < 0.05). Furthermore, the volumes of acid perfused at the onset of symptoms in the stricture group (median, 80 ml) were greater than in the oesophagitis group (median, 40; p < 0.05). These results support the hypothesis that patients who develop reflux-induced strictures have decreased sensitivity to intra-oesophageal acid. This may be a factor in the pathogenesis of reflux-induced strictures.