The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

Kasamatsu, Shingo; Matsumura, Tomoaki; Ohta, Yuki; Hamanaka, Shinsaku; Ishigami, Hideaki; Taida, Takashi; Okimoto, Kenichiro; Saito, Keiko; Maruoka, Daisuke; Nakagawa, Tomoo; Katsuno, Tatsuro; Fujie, Mai; Kikuchi, Atsuko; Arai, Makoto

doi:10.1159/000468925

Cited by 19 publications

(22 citation statements)

References 27 publications

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“…[21] However, other studies have reported no association between IEM and GERD. [22] This is in agreement with our finding of no significant correlation among esophageal motility disorders, GIP and PP levels, and AET. The CFV value was higher in the AET– group; however, the role of CFV is not emphasized in the CC ver.…”

Section: Discussionsupporting

confidence: 93%

Association of serum gastric inhibitory polypeptide and pancreatic polypeptide levels with prolonged esophageal acid exposure time in refractory gastroesophageal reflux disease

Chen¹,

Guo²,

Guo³

et al. 2019

Medicine

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Background: Acid exposure time (AET) prolongation plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD). Gastric inhibitory polypeptide (GIP) and pancreatic polypeptide (PP) participate in the regulation of gastric acid secretion, blood glucose and lipid levels, and food intake. In this study, we evaluated the serum GIP and PP levels in refractory GERD patients and analyzed their metabolic and motility characteristics. Methods: Seventy-three refractory GERD patients were enrolled in this study from September 2015 to September 2017. We investigated the clinical characteristics, severity, and duration of GERD symptoms. High-resolution manometry and 24 hours impedance-pH monitoring were performed to assess esophageal motility and reflux parameters. The patients were divided into the AET− group (AET <4.2%) and AET+ group (AET >4.2%). GIP and PP levels were determined in all subjects and their associations with other parameters evaluated. Results: Age and GERDQ score were significantly higher ( P < .05) and acid reflux and heartburn more frequent in the AET+ group than in the AET− group. The contraction front velocity was increased in the AET− group, while there was no significant difference in the distal contraction integral, peristalsis interruption, distal latency, or resting pressures of the lower and upper esophageal sphincters between the 2 groups ( P > .05). The serum levels of GIP ( P = .003) and PP ( P = .012) were significantly increased in the AET+ group. Increased GIP and PP levels were associated with abnormal upright AET (correlation coefficients 0.307 and 0.233, P = .008 and P = .047). There was a positive correlation between GIP and triglyceride levels (correlation coefficient 0.279, P = .017). Conclusion: The serum levels of GIP and PP in refractory GERD patients with prolongation of AET are significantly elevated, mainly in the upright position.

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Section: Discussionsupporting

confidence: 93%

Association of serum gastric inhibitory polypeptide and pancreatic polypeptide levels with prolonged esophageal acid exposure time in refractory gastroesophageal reflux disease

Chen¹,

Guo²,

Guo³

et al. 2019

Medicine

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show abstract

“…[ 9 ] Nevertheless, while a significant relationship was found between IEM and GERD in some studies, no relationship was found in others. [ 10 – 12 ] As a result, although pathological esophageal acid reflux and IEM are frequently associated, the presence of IEM is not considered pathognomonic for GERD. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux

Paköz¹,

Sarı

Vatansever³

et al. 2021

Medicine

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Ineffective esophageal motility (IEM), defined as minor esophageal motility disorder, is also the most common esophageal motility disorder. The relationship between gastro-esophageal reflux disease is still controversial. Our aim in this study is to evaluate whether there are differences in terms of demographic, endoscopic, or motility findings between IEM patients with pathological esophageal acid reflux and physiological reflux. Patients diagnosed with IEM according to the Chicago classification v3 with high-resolution manometry (HRM) before acid monitoring constituted the study group of our investigation. The patients were divided into 2 groups as patients with pathological esophageal reflux and patients with physiological reflux according to 24-hour acid monitoring. Demographic data, endoscopic findings, and HRM findings were compared between 2 groups. A total of 62 patients who were diagnosed with IEM according to the Chicago classification v3 were included in the study. Patients in the physiological reflux group were 7 years younger on average than the pathological reflux group. Esophagitis rates were significantly higher in the pathological reflux group ( P = .033). Lower esophageal sphincter resting pressure, integrated relaxation pressure, and the presence of hernia were found to be similar in the 2 groups ( P = 392, P = 182, P = 657, respectively). The rate of severe IEM was also similar between the 2 groups ( P = .143). The fact that the physiological reflux patient group is younger may suggest that the IEM develops in the early period and then reflux accompanies the picture with advancing age.

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“…Ineffective esophageal motility is frequently seen in patients with GERD [12]. However, the association between GERD and IEM is yet not fully understood and discussed very controversially [13, 14]. Notably, there are numerous reports, which show a possible connection between the IEM and impaired mucosal integrity caused by GERD [12, 15, 16].…”

Section: Discussionmentioning

confidence: 99%

Electrical lower esophageal sphincter augmentation in patients with GERD and severe ineffective esophageal motility—a safety and efficacy study

et al. 2019

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BackgroundLaparoscopic fundoplication (LF), even if performed in specialized centers, can be followed by long-term side effects such as dysphagia, gas bloating or inability to belch. Patients with an ineffective esophageal motility (IEM) and concurrent GERD are prone to postoperative dysphagia after LF. The aim of this study is to evaluate the safety and efficacy of electrical lower esophageal sphincter stimulation in patients with IEM and GERD.MethodsThis is a prospective, open-label single center study. Patients with PPI-refractory GERD and ineffective esophageal motility were included for lower esophageal sphincter electrical stimulation (LES-EST). Patients underwent prospective follow-up including physical examination, interrogation of the device and were surveyed for changes in the health-related quality of life score.ResultsAccording to power analysis, 17 patients were included in this study. Median distal contractile integral (DCI) was 64 mmHg s cm (quartiles 11.5–301). Median total % pH < 4 was 8.9 (quartiles 4–21.6). Twelve patients (70.6%) underwent additional hiatal repair. At 1-month follow-up, none of the patients showed any clinical or radiological signs of dysphagia. There were no procedure related severe adverse events. Mean total HQRL improved from baseline 37.53 (SD 15.07) to 10.93 (SD 9.18) at follow-up (FUP) (mean difference 24.0 CI 15.93–32.07) p < 0.001.ConclusionsLES-EST was introduced as a potential technique to avoid side effects of LF. LES-EST significantly improved health related quality of life and does not impair swallowing in patients with GERD and ineffective esophageal motility.

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The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

Cited by 19 publications

References 27 publications

Association of serum gastric inhibitory polypeptide and pancreatic polypeptide levels with prolonged esophageal acid exposure time in refractory gastroesophageal reflux disease

Association of serum gastric inhibitory polypeptide and pancreatic polypeptide levels with prolonged esophageal acid exposure time in refractory gastroesophageal reflux disease

Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux

Electrical lower esophageal sphincter augmentation in patients with GERD and severe ineffective esophageal motility—a safety and efficacy study

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