Gastroesophageal Reflux Disease (GERD) is the most common malady of the esophagus and affects over 20% of the US population. While mucosal injury in GERD responds adequately to medical therapy, remedying the GERD symptoms such as heartburn and sensation/awareness of the refluxate movement within the esophagus referred to as regurgitation movement especially in the absence of mucosal injury, which comprises nearly half of this patient population, poses a significant clinical challenge. Thi is primarily due to lack of clear understanding of the cerebral cortical mechanisms involved in sensory physiology and pathophysiology of GERD. The current proposal addresses this deficiency at two levels. At the cerebral cortical level in humans it utilizes advance imaging technology to characterize the effect of chronic and acute esophageal acid exposure on local and large scale cortical networks that are involved in visceral sensation, interoception/homeostasis and awareness in healthy individuals and patients with well defined various GERD sub-types including erosive and non erosive reflux disease as well as functional heartburn. The proposed animal studies will delineate the underlying cortical mechanisms of sensory pathophysiology in GERD using an integrated imaging, molecular, and electrophysiological approach. We have focused these studies on two animal models;repeated acid exposure and chronic erosive esophagitis. These resemble non-erosive and erosive reflux in humans. These investigations complement the human studies and will provide in depth insight into the effect of chronic and acute esophageal acid exposure on the cortex, insight that cannot be obtained from humans. The obtained information will increase our understanding of the cortical sensory pathophysiology of GERD and as such has the potential to lead to newer diagnostic and therapeutic modalities and positively impact clinical practice and potentially reduce health care expenditure. PHS 398/2590 (Rev. 06/09) Page Continuation Format Page
Gastroeophageal reflux disease (GERD) affects over 20% of the population. Reportedly 7-10% of US population suffers daily from heartburn the cardinal symptom of GERD. Mucosal injury in GERD is easily treated but remedying the symptom of heartburn in the absence of mucosal injury which constitute over half of these patients is a difficult clinical challenge which results in significant burden on the individual and society. Thi shortcoming is in part due to lack of a clear understanding of the brain processing of sensory information from the esophagus. The current proposal addresses this deficiency at two levels. At the whole brain level it will determine the effect of GERD on local and large scale cortical networks that are involved in visceral sensation, interoception/homeostasis and awareness. At the brain receptor level, it will determine how esophageal acid exposure can influence the neuronal receptors and their reaction to stimulation. Findings are anticipated to advance our understanding of the cortical mechanisms in sensory pathophysiology of GERD and help guide development of better diagnosis and therapy. PHS 398/2590 (Rev. 06/09) Page Continuation Format Page
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