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. 2001 Nov;49(5):624–628. doi: 10.1136/gut.49.5.624

Duodenal fat intensifies the perception of heartburn

J Meyer 1, A Lembo 1, J Elashoff 1, R Fass 1, E Mayer 1
PMCID: PMC1728491  PMID: 11600463

Abstract

BACKGROUND—Patients with gastro-oesophageal reflux disease (GORD) frequently report that meals high in fat worsen heartburn. Nevertheless, studies to determine whether high fat meals promote gastro-oesophageal reflux have produced conflicting and equivocal conclusions.
PATIENTS AND METHODS—To determine, alternatively, whether fat in the small intestinal lumen intensifies the perception of heartburn, we studied 11 patients with typical heartburn from GORD. After being placed on omeprazole to suppress endogenous acid, these fasting subjects underwent oesophageal perfusions with graded doses of HCl at pH values of 1.0, 1.5, 2.0, and 2.5. Oesophageal perfusions were conducted while the duodenum was perfused with saline (control) and again with fat at 8 g/h.
RESULTS—Time to onset, intensity, and severity of heartburn varied with dose of oesophageal acid (p<0.01). Time to onset was significantly (p<0.01) shorter, and intensity and severity of heartburn significantly (p<0.05) greater, during duodenal perfusion with fat.
CONCLUSION—We conclude that duodenal fat intensifies the perception of heartburn.


Keywords: gastro-oesophageal reflux disease; heartburn; perception; fat

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Figure 1  .

Figure 1  

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(A) Rank orders (mean (SEM) on a scale of 1-8) for times of onset of heartburn in the 11 subjects during duodenal perfusions with fat versus saline while the oesophagus was perfused with HCl at each of the four pH values (1.0, 1.5, 2.0, and 2.5). Ranks of 1.5 were assigned for oesophageal perfusions at pH 1.0 that were missing in two of the subjects (see text). (B-D) Mean (SEM) values for the 11 subjects during duodenal perfusions with fat versus saline while the oesophagus was perfused with HCl at each of four pH values. There are missing data for two of the 11 subjects when the oesophagus was perfused at pH 1.0 during duodenal instillations of fat and saline. (B) Time (seconds) to onset of heartburn (limits 0-301 seconds). (C) Perceived intensity of heartburn (mm on an analogue scale; limits 0-20 mm). (D) Severity of heartburn (duration×intensity; limits 0-6000 mm-second).

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