Cerebral electrical potentials evoked by balloon distention of the human esophagus

Abstract

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.

Conclusions: (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.