Ineffective motility is not a marker for gastroesophageal reflux disease

Abstract

IEM does not stand alone as a significant marker for the presence of GERD in general or supraesophageal reflux disease in particular.

Ineffective esophageal motility does not equate to GERD

“…A number of analyses suggest that the most profound determinant of prolonged acid clearance is hiatus hernia (14,15), and neither the report by Leite et al (6) nor the current report by Vinjirayer et al (1) provide data on hiatus hernia. A mechanistic study evaluating the efficacy of esophageal emptying in a large group of GERD patients and normal controls provided some insight into the relative significance of peristaltic dysfunction and hiatus hernia in the impairment of acid clearance (13).…”

“…These findings have led some investigators to suggest that IEM be considered a marker for GERD, that the disorder has pathophysiological significance, and that GERD severity may parallel the severity of this motor abnormality (2,3). The current study by Vinjirayer et al (1) suggests that the relationship between IEM and GERD may have been somewhat overstated.…”

“…Alternatively, Vinjirayer et al may have found no association because their method for defining GERD and stratifying disease severity was seriously flawed (1). Is it reasonable, after all, to take a symptomatic group of patients and conclude that only the subset with excessive esophageal acid exposure during an ambulatory esophageal pH monitoring study had GERD?…”

“…In challenging the association between IEM and GERD, Vinjirayer et al (1) are suggesting that the null hypothesis is true (e.g., that no association exists, and IEM might simply be an age-related phenomenon). Alternatively, Vinjirayer et al may have found no association because their method for defining GERD and stratifying disease severity was seriously flawed (1).…”

“…In this issue of The American Journal of Gastroenterology, Vinjirayer et al (1) test the hypothesis that ineffective esophageal motility (IEM) is a marker of gastroesophageal reflux disease (GERD) and conclude otherwise (2,3). By way of background, IEM is characterized by frequent hypotensive or failed peristaltic contractions and is found in 20 -50% of GERD patients (2)(3)(4)(5).…”