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Erschienen in: Digestive Diseases and Sciences 8/2019

30.04.2019 | Original Article

High-Resolution Manometry Diagnosis of Ineffective Esophageal Motility Is Associated with Higher Reflux Burden

verfasst von: Chanakyaram A. Reddy, Jason R. Baker, Joyee Lau, Joan W. Chen

Erschienen in: Digestive Diseases and Sciences | Ausgabe 8/2019

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Abstract

Introduction

Ineffective esophageal motility (IEM) is the most commonly diagnosed abnormality on high-resolution manometry (HRM). However, the clinical significance of IEM and associated reflux burden remains unclear.

Aim

Our primary aim was to compare reflux patterns between IEM versus normal motility on HRM.

Methods

HRM and reflux studies in patients with IEM and normal motility were retrospectively reviewed. Esophageal pressure topography parameters, reflux variables, and patient-reported outcome questionnaires were explored.

Results

A total of 239 patients with IEM were explored. Of these, 146 underwent reflux monitoring. Additionally, 100 patients with normal HRM all of whom had undergone reflux monitoring were included. IEM patients were more likely to have an abnormal number of reflux events compared to normal (22.7% vs. 9.0%, p < 0.01). Including only off-proton pump inhibitor (PPI) testing, IEM patients had higher mean total acid exposure time (AET) and total reflux events compared to normal motility (p = 0.02). Within IEM patients, higher AET modestly correlated with increased percentage of impaired swallows. Increased reflux events modestly correlated with higher impaired swallows and decreased lower esophageal sphincter (LES) resting pressure. Reflux burden increased with higher esophagogastric junction (EGJ) subtype, driven mostly by subtype III, although there was no difference in the distribution of EGJ subtypes between the IEM and normal HRM cohorts.

Conclusions

Patients with HRM diagnosis of IEM may be more prone to acid reflux while off-PPI and non-acid reflux while on-PPI. Reflux burden appears to be worse in IEM patients who have lower resting LES pressure, higher EGJ subtype, or higher percentage of impaired swallows.
Literatur
1.
Zurück zum Zitat Kahrilas PJ, Bredenoord A, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–174.CrossRef Kahrilas PJ, Bredenoord A, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–174.CrossRef
2.
Zurück zum Zitat Abdel Jalil AA, Castell DO. Ineffective esophageal motility (IEM): the old-new frontier in esophagology. Curr Gastroenterol Rep. 2016;18:1.CrossRefPubMed Abdel Jalil AA, Castell DO. Ineffective esophageal motility (IEM): the old-new frontier in esophagology. Curr Gastroenterol Rep. 2016;18:1.CrossRefPubMed
3.
Zurück zum Zitat Blonski W, Vela M, Safder A, Hila A, Castell DO. Revised criterion for diagnosis of ineffective esophageal motility is associated with more frequent dysphagia and greater bolus transit abnormalities. Am J Gastroenterol. 2008;103:699–704.CrossRefPubMed Blonski W, Vela M, Safder A, Hila A, Castell DO. Revised criterion for diagnosis of ineffective esophageal motility is associated with more frequent dysphagia and greater bolus transit abnormalities. Am J Gastroenterol. 2008;103:699–704.CrossRefPubMed
4.
Zurück zum Zitat Vinjirayer E, Gonzalez B, Brensinger C, et al. Ineffective motility is not a marker for gastroesophageal reflux disease. Am J Gastroenterol. 2003;98:771–776.CrossRefPubMed Vinjirayer E, Gonzalez B, Brensinger C, et al. Ineffective motility is not a marker for gastroesophageal reflux disease. Am J Gastroenterol. 2003;98:771–776.CrossRefPubMed
6.
Zurück zum Zitat Jain A, Baker JR, Chen JW. In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows. Neurogastroenterol Motil. 2018;30:e13297.CrossRefPubMed Jain A, Baker JR, Chen JW. In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows. Neurogastroenterol Motil. 2018;30:e13297.CrossRefPubMed
7.
Zurück zum Zitat Min YW, Shin I, Son HJ, Rhee PL. Multiple rapid swallow maneuver enhances the clinical utility of high-resolution manometry in patients showing ineffective esophageal motility. Medicine (Baltimore). 2015;94:e1669.CrossRef Min YW, Shin I, Son HJ, Rhee PL. Multiple rapid swallow maneuver enhances the clinical utility of high-resolution manometry in patients showing ineffective esophageal motility. Medicine (Baltimore). 2015;94:e1669.CrossRef
8.
Zurück zum Zitat Mello MD, Shriver AR, Li Y, Patel A, Gyawali CP. Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016;28:292–298.CrossRefPubMed Mello MD, Shriver AR, Li Y, Patel A, Gyawali CP. Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016;28:292–298.CrossRefPubMed
9.
Zurück zum Zitat Shaker A, Stoikes N, Drapekin J, Kushnir V, Brunt LM, Gyawali CP. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. Am J Gastroenterol. 2013;108:1706–1712.CrossRefPubMedPubMedCentral Shaker A, Stoikes N, Drapekin J, Kushnir V, Brunt LM, Gyawali CP. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. Am J Gastroenterol. 2013;108:1706–1712.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Rengarajan A, Bolkhir A, Gor P, Wang D, Munigala S, Gyawali CP. Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30:e13267.CrossRefPubMed Rengarajan A, Bolkhir A, Gor P, Wang D, Munigala S, Gyawali CP. Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30:e13267.CrossRefPubMed
11.
Zurück zum Zitat Ravi K, Friesen L, Issaka R, Kahrilas PJ, Pandolfino JE. Long-term outcomes of patients with normal or minor motor function abnormalities detected by high-resolution esophageal manometry. Clin Gastroenterol Hepatol. 2015;13:1416–1423.CrossRefPubMedPubMedCentral Ravi K, Friesen L, Issaka R, Kahrilas PJ, Pandolfino JE. Long-term outcomes of patients with normal or minor motor function abnormalities detected by high-resolution esophageal manometry. Clin Gastroenterol Hepatol. 2015;13:1416–1423.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Goyal O, Bansal M, Sood A. Esophageal motility disorders: symptomatic and manometric spectrum in Punjab, northern India. Indian J Gastroenterol. 2017;36:202–208.CrossRefPubMed Goyal O, Bansal M, Sood A. Esophageal motility disorders: symptomatic and manometric spectrum in Punjab, northern India. Indian J Gastroenterol. 2017;36:202–208.CrossRefPubMed
13.
Zurück zum Zitat Roman S, Pandolfino JE, Chen J, Boris L, Luger D, Kahrilas PJ. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT). Am J Gastroenterol. 2012;107:37–45.CrossRefPubMed Roman S, Pandolfino JE, Chen J, Boris L, Luger D, Kahrilas PJ. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT). Am J Gastroenterol. 2012;107:37–45.CrossRefPubMed
14.
Zurück zum Zitat Jonasson C, Wernersson B, Hoff DA, Hatlebakk JG. Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013;37:564–572.CrossRefPubMed Jonasson C, Wernersson B, Hoff DA, Hatlebakk JG. Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013;37:564–572.CrossRefPubMed
16.
Zurück zum Zitat Nicodeme F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–360.CrossRefPubMed Nicodeme F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–360.CrossRefPubMed
17.
Zurück zum Zitat Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–1031.CrossRefPubMedPubMedCentral Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–1031.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Monrroy H, Cisternas D, Bilder C, et al. The Chicago classification 3.0 results in more normal findings and fewer hypotensive findings with no difference in other diagnoses. Am J Gastroenterol. 2017;112:606–612.CrossRefPubMed Monrroy H, Cisternas D, Bilder C, et al. The Chicago classification 3.0 results in more normal findings and fewer hypotensive findings with no difference in other diagnoses. Am J Gastroenterol. 2017;112:606–612.CrossRefPubMed
20.
Zurück zum Zitat Reddy CA, Patel A, Gyawali CP. Impact of symptom burden and health-related quality of life (HRQOL) on esophageal motor diagnoses. Neurogastroenterol Motil. 2017;29:e12970.CrossRef Reddy CA, Patel A, Gyawali CP. Impact of symptom burden and health-related quality of life (HRQOL) on esophageal motor diagnoses. Neurogastroenterol Motil. 2017;29:e12970.CrossRef
21.
Zurück zum Zitat Kasamatsu S, Matsumura T, Ohta Y, et al. The effect of ineffective esophageal motility on gastroesophageal reflux disease. Digestion. 2017;95:221–228.CrossRefPubMed Kasamatsu S, Matsumura T, Ohta Y, et al. The effect of ineffective esophageal motility on gastroesophageal reflux disease. Digestion. 2017;95:221–228.CrossRefPubMed
22.
Zurück zum Zitat Jiang L, Ye B, Wang Y, Wang M, Lin L. Esophageal body motility for clinical assessment in patients with refractory gastroesophageal reflux symptoms. J Neurogastroenterol Motil. 2017;23:64–71.CrossRefPubMedPubMedCentral Jiang L, Ye B, Wang Y, Wang M, Lin L. Esophageal body motility for clinical assessment in patients with refractory gastroesophageal reflux symptoms. J Neurogastroenterol Motil. 2017;23:64–71.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Shetler KP, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30:1–8.CrossRefPubMed Shetler KP, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30:1–8.CrossRefPubMed
24.
Zurück zum Zitat Tolone S, de Cassan C, de Bortoli N, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27:1175–1182.CrossRefPubMed Tolone S, de Cassan C, de Bortoli N, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27:1175–1182.CrossRefPubMed
Metadaten
Titel
High-Resolution Manometry Diagnosis of Ineffective Esophageal Motility Is Associated with Higher Reflux Burden
verfasst von
Chanakyaram A. Reddy
Jason R. Baker
Joyee Lau
Joan W. Chen
Publikationsdatum
30.04.2019
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 8/2019
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-019-05633-3

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