Impact of ineffective esophageal motility on chemical clearance in patients with gastroesophageal reflux symptoms

Abstract

Summary Ineffective esophageal motility (IEM) is the most common manometric abnormality in gastroesophageal reflux disease (GERD). However, the impact of IEM on esophageal chemical clearance has not been fully investigated. This study aimed to determine the impact of IEM on esophageal chemical clearance in patients with GERD. A total of 369 patients with GERD symptoms who underwent upper endoscopy and high-resolution manometry (HRM) test were retrospectively analyzed. The relationship between IEM and erosive esophagitis was examined. In addition, the impact of IEM on chemical clearance was examined in patients who underwent an additional combined multichannel intraluminal impedance–pH (MII–pH) test. Esophageal chemical clearance capability was evaluated via postreflux swallow-induced peristaltic wave (PSPW) index and acid clearance time (ACT). Of 369 patients, 181 (49.1%) had esophageal motility disorders, of which 78 (21.1%) had IEM. The proportion of IEM patients in those with erosive esophagitis and those without were 16.2% and 21.7%, respectively, and no significant difference was observed (P = 0.53). After excluding patients other than those with IEM and normal esophageal motility, 64 subsequently underwent MII–pH test. The median values of the PSPW index in the IEM and normal esophageal motility group were 11.1% (4.2%–20.0%) and 17.1% (9.8%–30.6%), respectively. The PSPW index was significantly lower in the IEM group than in the normal esophageal motility group (P < 0.05). The median ACT values in the IEM group and normal esophageal motility group were 125.5 (54.0–183.5) seconds and 60.0 (27.2–105.7) seconds, respectively. The ACT was significantly longer in the IEM group than in the normal esophageal motility group (P < 0.05). In conclusion, IEM was found to be associated with chemical clearance dysfunction as measured against the PSPW index and ACT. As this condition could be a risk factor for GERD, future treatments should be developed with a focus on chemical clearance.

Effect of electrical stimulation therapy of the lower esophageal sphincter in GERD patients with ineffective esophageal motility

“…As the patient cohort of Rodriguez did not include any patients with IEM, more advanced disease in our population may be responsible for that outcome. Recently, IEM was even associated with dysfunction of chemical clearance [20]. However, comparing our results to patients with defective esophageal motility after fundoplication at least some partial response in acid reduction was expected [21].…”

High prevalence of esophagitis in patients with severe ineffective esophageal motility: need for a new diagnostic cutoff

“…A 2018 study of 188 patients who underwent HRM and pH monitoring examined the cutoff to classify IEM using the Chicago Classification version 3.0, showing that patients with a higher proportion of ineffective and failed swallows were associated with higher total acid exposure time on pH monitoring [ 26 ]. Other studies have failed to find an association between IEM and GERD, although IEM was associated with prolonged acid exposure time and impaired esophageal clearance capacity [ 27 - 29 ]. Therefore, the observed higher prevalence of esophagitis in patients with severe IEM could be due to more impaired reflux clearance, suggesting that severe IEM should be distinguished from mild IEM because the patients might have different risks of developing esophagitis.…”

Ineffective Esophageal Motility: Need for Improvement in Diagnostic Criteria

“…Median ACT was significantly longer in the IEM group. 18 Poor secondary peristalsis might also contribute to the mechanism of reflux disease in IEM. Secondary peristalsis induced by rapid mid-esophageal air injection was more frequently induced in healthy controls than in GERD patients and GERD patients with IEM had a lower rate of secondary peristalsis than GERD patients without IEM.…”