Influence of capsaicin infusion on secondary peristalsis in patients with gastroesophageal reflux disease

Abstract

Aim: To determine whether capsaicin infusion could influence heartburn perception and secondary peristalsis in patients with gastroesophageal reflux disease (GERD).

Methods: Secondary peristalsis was performed with slow and rapid mid-esophageal injections of air in 10 patients with GERD. In a first protocol, saline and capsaicin-containing red pepper sauce infusions were randomly performed, whereas 2 consecutive sessions of capsaicin-containing red pepper sauce infusions were performed in a second protocol. Tested solutions including 5 mL of red pepper sauce diluted with 15 mL of saline and 20 mL of 0.9% saline were infused into the mid-esophagus via the manometric catheter at a rate of 10 mL/min with a randomized and double-blind fashion. During each study protocol, perception of heartburn, threshold volumes and peristaltic parameters for secondary peristalsis were analyzed and compared between different stimuli.

Results: Infusion of capsaicin significantly increased heartburn perception in patients with GERD (P < 0.001), whereas repeated capsaicin infusion significantly reduced heartburn perception (P = 0.003). Acute capsaicin infusion decreased threshold volume of secondary peristalsis (P = 0.001) and increased its frequency (P = 0.01) during rapid air injection. The prevalence of GERD patients with successive secondary peristalsis during slow air injection significantly increased after capsaicin infusion (P = 0.001). Repeated capsaicin infusion increased threshold volume of secondary peristalsis (P = 0.002) and reduced the frequency of secondary peristalsis (P = 0.02) during rapid air injection.

Conclusion: Acute esophageal exposure to capsaicin enhances heartburn sensation and promotes secondary peristalsis in gastroesophageal reflux disease, but repetitive capsaicin infusion reverses these effects.

Keywords: Capsaicin; Esophageal manometry; Esophageal motility; Gastroesophageal reflux disease; Secondary peristalsis.

Figure 1

Influence of capsaicin-containing red pepper sauce on heartburn symptom. A: Capsaicin infusion induces a significant increase in the visual analog scale for heartburn symptom when compared with saline (P < 0.001); B: The visual analog scale for heartburn symptom is significantly decreased by repeated capsaicin infusion than first session of capsaicin infusion (P = 0.003). Values are expressed as mean ± SE of the mean. Line represents the mean value.

Figure 2

Influence of capsaicin-containing red pepper sauce on distension threshold to induce secondary peristalsis during rapid air injection. A: The threshold volume for inducing secondary peristalsis is significantly decreased after capsaicin when compared with saline infusion (P = 0.001); B: Secondary peristalsis is triggered more frequently after capsaicin infusion than saline infusion (P = 0.01). Values are expressed as mean ± SE of the mean or median with interquartile range. Line represents the mean or median value.

Figure 3

Influence of capsaicin-containing red pepper sauce on the prevalence of successive secondary peristalsis during slow air injection. A: The prevalence of patients with successive secondary peristalsis increases after capsaicin infusion than saline infusion (P = 0.001); B: There are no difference in the prevalence of patients with successive secondary peristalsis between first and second capsaicin infusions (P = 0.18).

Figure 4

Influence of repeated capsaicin-containing red pepper sauce on distension threshold to induce secondary peristalsis during rapid air injection. A: The threshold volume for inducing secondary peristalsis is significantly greater after second infusion of capsaicin than first infusion of capsaicin (P = 0.002); B: Secondary peristalsis is triggered less frequently after second infusion of capsaicin than first infusion of capsaicin (P = 0.02). Values are expressed as mean ± SE of the mean or median with interquartile range. Line represents the mean or median value.