Esophageal Body Motility for Clinical Assessment in Patients with Refractory Gastroesophageal Reflux Symptoms

Neurogastroenterology Motil

Wang

et al. 2019

BackgroundThe pathophysiological mechanism(s) of gastroesophageal reflux disease (GERD)‐related chronic cough (CC) is unclear. We aimed to determine the mechanism of reflux‐induced cough by synchronous monitoring of reflux episodes, esophageal motility, and cough.MethodsPatients with GERD were prospectively enrolled and classified into GERD with CC (GERD‐CC) and without CC (GERD) groups. Twenty‐four‐hour ambulatory pH‐impedance‐pressure monitoring was performed; the reflux patterns, esophageal motility during prolonged exposure to acid and characteristics of reflux episodes that induced coughing paroxysms were analyzed.Key ResultsThirty‐one patients with GERD‐CC and 47 with GERD were enrolled; all of whose monitoring results fulfilled the criteria for diagnosis of GERD. Patients with GERD‐CC had higher reflux symptom scores, longer exposure to acid, higher DeMeester scores, and more frequent reflux episodes, proximal extent reflux detected by impedance, and higher percentage of strongly acidic reflux than patients in the GERD group (all P < .05). Of 63 reflux‐cough episodes identified in the GERD‐CC group, 74.6% of distal reflux and 67.0% of proximal reflux episodes were acidic. More patients had low pan‐esophageal pressure in primary peristalsis (48.5% vs 11.8%, P = .000) and synchronous contraction in secondary peristalsis during prolonged exposure to acid in the GERD‐CC than in the GERD group (63.9% vs 9.1%, P = .000).Conclusions & InferencesProximal acidic reflux and distal reflux‐reflex are jointly associated with reflux‐induced cough in patients with GERD. Low pan‐esophageal pressure in primary peristalsis and synchronous contraction in secondary peristalsis may play important roles in GERD‐associated chronic cough.

Section: Discussionmentioning

confidence: 99%

“…Ineffective esophageal motility and large breaks are associated with reflux‐cough events. Meanwhile, long‐term exposure to acid is negatively correlated with esophageal body motility . To the best of our knowledge, few studies have investigated esophageal motility during long‐term acid reflux in individuals with CC and GERD.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

Neurogastroenterology Motil

Wang

et al. 2019

“…Patients with reflux esophagitis had a lower DCI than patients without reflux esophagitis in one study (558 mmHg•sec•cm vs 782 mmHg•sec•cm, respectively; P = 0.045). 34 To distinguish the contraction pattern from contractile vigor, the Chicago classification proposed small breaks (< 3 cm) and large breaks (> 5 cm) in the 20-mmHg isobaric contour. The latter is more common in patients with GERD, who have a pathological number of large breaks assessed by HRM, and are characterized by having a significantly prolonged reflux clearance in the supine position and higher esophageal acid exposure time.…”

Section: Ineffective Primary Peristalsismentioning

confidence: 99%

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

J Neurogastroenterol Motil

Fang

2019

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional highresolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the antireflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.

“…It has been reported that there are more reflux episodes, longer acid exposure, and slower esophageal acid clearance in GERD patients with ineffective esophageal motility (IEM) compared with those with normal esophageal motility . Our previous study also demonstrated that refractory GERD patients with IEM had more episodes of weakly acid reflux and long‐term acid reflux than those with normal esophageal motility . To date, it has been impossible to determine whether esophageal dysmotility is the primary cause or a secondary abnormality in the development of GERD.…”

Section: Introductionmentioning

confidence: 99%

“…9 Our previous study also demonstrated that refractory GERD patients with IEM had more episodes of weakly acid reflux and long-term acid reflux than those with normal esophageal motility. 10 To date, it has been impossible to determine whether esophageal dysmotility is the primary cause or a secondary abnormality in the development of GERD.…”

Section: Introductionmentioning

confidence: 99%

Acid exposure in patients with gastroesophageal reflux disease is associated with esophageal dysmotility

Jiang

Wang

2019

J of Digest Diseases

Self Cite

Objective To explore the correlation between reflux disease and abnormal esophageal motility in patients with gastroesophageal reflux disease (GERD). Methods Participants (patients with GERD and controls) who underwent 24‐h impedance‐pH monitoring (MII‐pH monitoring) and high‐resolution manometry between January 2012 and February 2017 were retrospectively studied. The patients were divided into two groups (acid reflux and nonacid reflux) based on their MII‐pH monitoring data. Reflux episodes, endoscopic findings, and esophageal dynamic parameters were assessed and compared. Results A total of 142 patients were included (acid reflux [n = 58], nonacid reflux [n = 60], control group [n = 24]). There were more patients with esophagitis and more severe esophageal mucosal injury in the acid reflux group than in the nonacid reflux group. The acid reflux group had reduced lower esophageal sphincter (LES) basal pressure, shorter LES length, lower esophageal pressure and distal contractile integral index than the nonacid reflux group. Patients in the acid reflux group had more large breaks and a higher incidence of type II and III esophagogastric junction morphology than those in the nonacid reflux group. Acid exposure time, the incidence of long‐term acid reflux, recumbent acid reflux, and the incidence of acid and nonacid reflux had a significant negative correlation with esophageal body motility or LES function. Conclusion This study suggests that an increase in esophageal acid exposure is correlated with an increase in esophageal dysmotility in patients with GERD.