Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

Abstract

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional highresolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the antireflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.

Hypopharyngeal‐Esophageal Impedance‐pH Monitoring Profiles of Laryngopharyngeal Reflux Patients

“…Regarding our data, three‐quarters of HREs occurred in the daytime, while upright, and outside postmeal times, which is different from the typical profile of GERD patients. In GERD patients, the distal reflux episodes mainly occur in the 60 minutes postmeal through many mechanisms involving the lowest LES pressure after eating, transient relaxations of the LES, and high pressure of the gastric content on the esophagogastric junction 17 . Transient relaxations of the LES allow the movement of gas from the proximal stomach to the distal esophagus while preventing reflux of gastric contents.…”

“…Transient relaxations of the LES allow the movement of gas from the proximal stomach to the distal esophagus while preventing reflux of gastric contents. However, it has been demonstrated that transient relaxations of LES frequently occur in reflux patients, leading to an escape of gastric contents into the esophagus, especially within 15 minutes after eating in patients with an acid pocket 17 . Thus, the gastric juice near the cardia may leak backward into the esophagus, which increases the incidence of postprandial reflux events 17,18 .…”

“…However, it has been demonstrated that transient relaxations of LES frequently occur in reflux patients, leading to an escape of gastric contents into the esophagus, especially within 15 minutes after eating in patients with an acid pocket 17 . Thus, the gastric juice near the cardia may leak backward into the esophagus, which increases the incidence of postprandial reflux events 17,18 . The incidence of transient LES relaxations in GERD patients would be more than two times that of healthy people, 19 and would be associated with a high probability to develop acid reflux 20,21 .…”

Efficacy of Chinese Herbal Formula Sini Zuojin Decoction in Treating Gastroesophageal Reflux Disease: Clinical Evidence and Potential Mechanisms

“…Gastroesophageal reflux disease (GERD) (Zhang et al, 2017;Lin et al, 2019) refers to a comprehensive disease of reflux symptoms caused by reflux of gastric or duodenal content back up the esophagus or throat. It is usually diagnosed by the combination of clinical symptoms, reaction to acid suppression, objective endoscopy, and reflux monitoring (Cesario et al, 2018).…”

A comparison of the efficacy and safety of complementary and alternative therapies for gastroesophageal reflux disease

“…Although PPIs are currently the most effective treatment for GERD and its complications, up to 40% of patients with nonerosive reflux disease remain symptomatic on standard therapy, and approximately 10% to 15% of patients. [ 8 – 10 ] Besides, it is reported that chronic PPI use is associated with an increase in the risk of gastric cancer. It might also be an independent risk factor for gastric cancer.…”