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

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.
Competing Interests: Conflict-of-interest statement: There are no conflicts of interest to report.