A Positive Correlation Between Gastric and Esophageal Dysmotility Suggests Common Causality

Zikos, Thomas; Clarke, John O.; Triadafilopoulos, George; Regalia, Kirsten; Sonu, Irene; Fernandez‐Becker, Nielsen; Nandwani, Monica; Nguyen, Linda Anh B.

doi:10.1007/s10620-018-5175-4

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…In Zikos et al's [8] study, the presence of nausea and vomiting was an inverse predictor of an HRM abnormality, a finding consistent with the observation that only 36.9% of the studied cohort had nausea and emesis, in line with observation that relatively more patients with gastric motility disorders experience nausea and emesis in contrast to the more frequently experienced symptoms such as dysphagia and heartburn in patients with esophageal motility disorders.…”

supporting

confidence: 76%

“…The presence of nausea, gastroesophageal reflux disease (GERD), atypical chest pain, dyspepsia, and dysphagia were not good predictors for an abnormal GES. Dysphagia was a positive predictor for an HRM abnormality, whereas the presence of nausea and vomiting was a negative predictor of HRM abnormality [8].…”

mentioning

confidence: 87%

“…Researchers from Stanford University have gone one step further through looking at HRM and GES data in patients who subjected to both tests [8,9]. In the current issue of Digestive Diseases and Sciences, Zikos et al have published an interesting article correlating abnormal GES and HRM.…”

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confidence: 99%

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Overlap Between Gastric and Esophageal Motility Disorders: A Contractual Arrangement?

Bashashati

Hejazi

2018

Dig Dis Sci

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confidence: 76%

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confidence: 87%

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Overlap Between Gastric and Esophageal Motility Disorders: A Contractual Arrangement?

Bashashati

Hejazi

2018

Dig Dis Sci

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“…Potential implications of IEM relate to GERD severity, symptom reporting, and decision making prior to antireflux surgery. Ineffective esophageal motility has a higher prevalence in smooth muscle disorders, such as scleroderma, other connective tissue disorders and gastroparesis, but is not more common in diabetes mellitus, or hypothyroidism . Ineffective esophageal motility has also been reported in Parkinson's disease .…”

Section: Discussionmentioning

confidence: 99%

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

Gyawali

Sifrim

Carlson

et al. 2019

Neurogastroenterology Motil

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Background Ineffective esophageal motility (IEM) is a heterogenous minor motility disorder diagnosed when ≥50% ineffective peristaltic sequences (distal contractile integral <450 mm Hg cm s) coexist with normal lower esophageal sphincter relaxation (integrated relaxation pressure < upper limit of normal) on esophageal high‐resolution manometry (HRM). Ineffective esophageal motility is not consistently related to disease states or symptoms and may be seen in asymptomatic healthy individuals. Purpose A 1‐day symposium of esophageal experts reviewed existing literature on IEM, and this review represents the conclusions from the symposium. Severe IEM (>70% ineffective sequences) is associated with higher esophageal reflux burden, particularly while supine, but milder variants do not progress over time or consistently impact quality of life. Ineffective esophageal motility can be further characterized using provocative maneuvers during HRM, especially multiple rapid swallows, where augmentation of smooth muscle contraction defines contraction reserve. The presence of contraction reserve may predict better prognosis, lesser reflux burden and confidence in a standard fundoplication for surgical management of reflux. Other provocative maneuvers (solid swallows, standardized test meal, rapid drink challenge) are useful to characterize bolus transit in IEM. No effective pharmacotherapy exists, and current managements target symptoms and concurrent reflux. Novel testing modalities (baseline and mucosal impedance, functional lumen imaging probe) show promise in elucidating pathophysiology and stratifying IEM phenotypes. Specific prokinetic agents targeting esophageal smooth muscle need to be developed for precision management.

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“…[8][9][10] Several prior studies have shown a significant overlap between dyspeptic and lower gastrointestinal (GI) symptoms, such as constipation and irritable bowel syndrome. [11][12][13] Additionally, prior studies suggest a link between gastroparesis and both esophageal dysmotility 14 and small bowel dysmotility. 15 These relationships suggest that a common pathophysiology may explain symptoms in multiple areas of the GI tract.…”

Section: Introductionmentioning

confidence: 98%

High Prevalence of Slow Transit Constipation in Patients With Gastroparesis

Zikos

Kamal

Neshatian

et al. 2019

J Neurogastroenterol Motil

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Background/Aims Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated. Methods We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups. Results Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings. Conclusions Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.

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A Positive Correlation Between Gastric and Esophageal Dysmotility Suggests Common Causality

Abstract: The correlation between an abnormal GES and HRM argues for common pathogenic mechanisms of these motility disorders, and possibly common future treatment options. Clinicians should have a high index of suspicion for another motility disorder if one is present.

Cited by 19 publications

References 23 publications

Overlap Between Gastric and Esophageal Motility Disorders: A Contractual Arrangement?

Overlap Between Gastric and Esophageal Motility Disorders: A Contractual Arrangement?

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

High Prevalence of Slow Transit Constipation in Patients With Gastroparesis

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