Esophageal acid sensitivity in patients with gastroesophageal reflux disease: Does esophageal hypomotility matter?

Abstract

Background/Aim Esophageal acid sensitivity plays a role in symptomatic manifestation of gastroesophageal reflux disease (GERD). Esophageal hypomotility is common in patients with GERD. We aimed to determine whether esophageal acid sensitivity may differ between patients with and without esophageal hypomotility. Methods We prospectively enrolled 41 consecutive patients (10 females, mean age 53 years, range 32‐79) with typical reflux symptoms and 10 healthy subjects (5 females, mean age 45 years, range 28‐56) for esophageal acid sensitivity and motility tests. Demographics, body mass index (BMI), and reflux symptoms using a validated questionnaire (GERDQ) were recorded. All subjects underwent infusion of 0.1 N hydrochloric acid in the esophagus at a rate of 10 mL/min for 10 minutes. The parameters for esophageal acid infusion included lag time, intensity rating, and acid sensitivity score. Results Esophageal motility diagnosis included 24 patients with normal motility and 17 patients with ineffective esophageal motility (IEM). Lag time was similar between the patient groups. No differences between patients with normal motility and IEM were found for any of other acid infusion parameters. There was a positive correlation between lag time and BMI (r = .33, P = .04). GERDQ was negatively correlated to lag time (r = −.73, P < .001). Conclusions Esophageal acid sensitivity was similar in GERD patients with and without hypomotility. Decreased acid sensitivity in individuals with increasing body mass index may play a pathological role in symptomatic modulation of patients with GERD.

Esophageal secondary peristalsis following acid infusion and chemical clearance correlate with mucosal integrity and acid sensitivity in GERD patients

“… 6 Esophageal acid sensitivity has been shown to positively correlate with GERD symptom severity and negatively correlate with mucosal integrity. 7 – 9 The esophageal hypervigilance and anxiety scale (EHAS) is a validated tool used to evaluate cognitive-affective aspects of centrally mediated esophageal symptom perception. 10 Previous studies have demonstrated that GERD symptom severity positively correlates with EHAS levels rather than traditional reflux metrics.…”

“… 20 Studies have shown that lower PSPW index values are linked to erosive GERD in comparison to non-erosive GERD, and very low PSPW index values can predict neoplastic progression in short-segment Barrett’s esophagus. 20 , 21 Although esophageal acid sensitivity is similar in GERD patients with and without ineffective esophageal motility, 9 the correlation between esophageal acid sensitivity and secondary peristalsis as well as PSPW index has not been studied.…”

Clinical efficacy and mechanism of transcutaneous neuromodulation on ineffective esophageal motility in patients with gastroesophageal reflux disease

“…A large number of studies have found that the esophageal body motion mode of GERD patients is mainly ineffective esophageal motility (IEM) 4 . IEM is very common in patients with GERD 5 . More and more studies believe that there is a clinical and functional correlation between IEM and GERD, often accompanied by abnormal esophageal transport.…”

“…4 IEM is very common in patients with GERD. 5 More and more studies believe that there is a clinical and functional correlation between IEM and GERD, often accompanied by abnormal esophageal transport. 6,7 Ho SC et al considered IEM as a specific entity for primary esophageal modynamic disorder.…”