What Is the Real Impairment on Esophageal Motility in Patients With Gastroesophageal Reflux Disease?

Abstract

Context Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD) as reduced lower esophageal sphincter (LES) basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Objective Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. Methods The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. Results The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (<30 mm Hg); this same group showed higher percentage of esophageal motility disorders. Conclusions The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility.

Predictive value of routine esophageal high‐resolution manometry for gastro‐esophageal reflux disease

“…This is mainly due to a large variation in basal LES pressure and wave amplitude among patients with reflux disease, resulting in a large overlap between GERD patients and controls. Subgroup analysis suggests an increasing prevalence of esophageal motility abnormalities with increasing severity of GERD, from non‐erosive reflux disease via erosive reflux disease to Barrett's esophagus . For this reason, no obvious cut‐off point can be determined for LES pressures or wave amplitudes to allow HRM as a diagnostic test for GERD.…”

“…Using conventional manometry, reduced lower esophageal sphincter (LES) pressure, low peristaltic amplitude and/or impaired peristalsis in the esophageal body are often seen in GERD patients . A low LES pressure might facilitate the occurrence of gastro‐esophageal reflux, while abnormal esophageal peristalsis and lower distal contractions may contribute to impaired esophageal clearance of refluxate . It remains somewhat controversial whether these motility changes are cause or consequence of GERD .…”

“…[3][4][5] A low LES pressure might facilitate the occurrence of gastro-esophageal reflux, while abnormal esophageal peristalsis and lower distal contractions may contribute to impaired esophageal clearance of refluxate. 2,6,7 It remains somewhat controversial whether these motility changes are cause or consequence of GERD. 1,2,6 In several previous studies, conventional manometry was found unable to serve as a tool for diagnosing GERD.…”

Effect of Laparoscopic Antireflux Surgery on Esophageal Motility

“…Esophageal dysmotility in patients with GERD is seen in many cases [1,16,17]. It is still unclear whether motility disorders are the primary defect inducing GERD, or caused by the lacerating effects of GERD.…”

“…Impaired esophageal motility (IEM) is frequently diagnosed in patients that undergo esophageal manometry as part of a functional assessment of gastroesophageal reflux disease (GERD) [1]. The etiology of IEM in GERD is incompletely understood and probably multifactorial [2].…”