Brain activity following esophageal acid infusion using positron emission tomography

Shigeyuki Kobayashi, Yasuhiko Abe, Manabu Tashiro, Tomoyuki Koike, Katsunori Iijima, Akira Imatani, Shuichi Ohara, Satoshi Watanabe, Shin Fukudo, Tooru Shimosegawa

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


AIM: To investigate symptoms and brain activity following esophageal acid infusion. METHODS: Fifteen healthy volunteers were recruited for the study. Hydrochloric acid (pH 1 and 2) and distilled water (pH 7) were randomly and repeatedly infused into the esophagus. The brain activity was evaluated by positron emission tomography. The severity of heartburn elicited by the infusion was rated on an auditory analog scale of 0-10. RESULTS: The severity of heartburn following each infusion showed a step-wise increase with increasing acidity of the perfusate. The heartburn scores were significantly higher in the second pH 1 infusion compared with the first infusion. Acid and distilled water infusion induced activation of various brain areas such as the anterior insula, temporal gyrus, and anterior/ posterior cingulate cortex. At pH 1 or 2, in particular, activation was observed in some emotion-related brain areas such as the more anterior part of the anterior cingulate cortex, parahippocampal gyrus, or the temporal pole. Strong activation of the orbitofrontal cortex was found by subtraction analysis of the two second pH 1 infusions, with a significant increase of heartburn symptoms. CONCLUSION: Emotion-related brain areas were activated by esophageal acid stimulation. The orbitofrontal area might be involved in symptom processing, with esophageal sensitization induced by repeated acid stimulation.

Original languageEnglish
Pages (from-to)5481-5489
Number of pages9
JournalWorld Journal of Gastroenterology
Issue number43
Publication statusPublished - 2010 Nov 21


  • Brain imaging
  • Esophageal acid infusion
  • Positron emission tomography

ASJC Scopus subject areas

  • Gastroenterology


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