Clinical symptoms, endoscopic findings, and lower esophageal sphincter characteristics in patients with absent contractility

Abstract

Absent contractility is a rare esophageal motility disorder defined by high-resolution manometry which remains poorly understood in pathogenesis and management. We investigated the clinical symptoms, upper gastrointestinal endoscopy findings, and lower esophageal sphincter (LES) characteristics in adult patients diagnosed with absent contractility on high resolution manometry and factors associated with erosive esophagitis that were found on endoscopy in these patients. A cross-sectional study was conducted in patients with absent contractility who were examined at the Institute of Gastroenterology and Hepatology, Vietnam between March 2018 and December 2020. Clinical symptoms, endoscopic findings, and LES metrics were collected and compared between individuals with and without erosive esophagitis. Logistic regression analysis was used to examine a variety of factors associated with erosive esophagitis. Among 7519 patients who underwent high resolution manometry, 204 (2.7%) were diagnosed with absent contractility. The mean age of the study sample was 45.9 years, 65.7% were women, and none had systemic sclerosis. The most common symptoms were regurgitation, belching, epigastric pain, and bloating. On endoscopy, 50% had erosive esophagitis, mostly Los Angeles grade A (42.9%). On manometry, 44.6% of the patients had LES hypotension and 68.1% had low integrated relaxation pressure in 4 seconds (IRP4s). Male sex (adjusted odds ratio = 2.01, 95% confidence interval: 1.04–3.89) and an IRP4s < 5 mm Hg (adjusted odds ratio = 2.21, 95% confidence interval: 1.12–4.37) were significantly associated with erosive esophagitis. Absent contractility was present in many patients without known systemic diseases. Erosive esophagitis was common and associated with male sex and low IRP4s.

Journey into the Esophageal Complications: Decoding Systemic Sclerosis with Cutting-Edge Endoscopy, Manometry, and Ambulatory pH-Study

“…The abnormalities were recorded using esophageal manometry, in which the patients frequently suffered from both abnormal esophageal sphincter pressure and contraction (DLESP and DDEPC), as has been reported in other studies. 35 , 36 In addition, reflux was reported in most patients using pH monitoring, and Arif et al (2015) also reported a high prevalence of reflux in his study. 37 Consistent with the other study employing videofluorography, signs of esophageal reflux were reported in most patients.…”

Approach to esophageal absent contractility: can we do better?

“…Subsequent studies from Spain (43.1%) [ 25 ], Japan (40.7%) [ 26 ], the United States (37.3%) [ 27 ], and Israel (21.6%) [ 28 ] confirmed that a significant percentage of AC patients have an underlying rheumatologic or autoimmune disease. In contrast, in a study from Vietnam, none of the 204 patients with AC had any rheumatologic disease [ 29 ]. These findings are summarized in Table 2 .…”

“…Additionally, the populations being evaluated are likely to have played a major role. From these studies, it appears that the study by Dao et al is an outlier, given its lack of any rheumatologic diseases [ 29 ], but so is the study by Laique et al , with its extremely high rate [ 4 ]. Thus, it appears that the true percentage of AC patients with an underlying rheumatologic disease is likely to be in the 21-43% range seen in most of the other studies, and not >80% as was found in the Laique et al study.…”