Esophageal motility abnormalities in gastroesophageal reflux disease

Abstract

Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

“…Although the association between GERD and esophageal dysmotility is clear, GERD symptoms relief after medical therapy is not proven to be helpful in improving esophageal motility. In fact, although PPIs are able to fully resolve reflux esophagitis and are successful in the majority of patients in terms of symptom relief, it has been shown that they have no effect on the improvement of esophageal body motility[61]. On the other hand, the surgical correction of GERD offers an improvement or a complete resolution of esophageal dysmotility[62].…”

Long-term Outcomes of Patients With Normal or Minor Motor Function Abnormalities Detected by High-resolution Esophageal Manometry

“…4,5 However, despite this some have suggested an association between weak esophageal peristalsis and gastroesophageal reflux (GERD). 6–8 Other studies have also suggested that minor motor abnormalities may be precursors to major motor abnormalities such as achalasia. 9 We sought to define the natural history of patients with normal findings and minor manometric abnormalities found initially on high resolution esophageal manometry.…”

Predictive value of routine esophageal high‐resolution manometry for gastro‐esophageal reflux disease

“…Hypotensive LES, short LES length, ineffective esophageal peristalsis and a longer transition zone have been described in patients with reflux disease . Some studies suggest an increasing prevalence of esophageal motility abnormalities with increasing severity of GERD, from non‐erosive reflux disease to erosive reflux disease and Barrett's esophagus . However, other studies found no differences in HRM parameters in subjects with GERD compared to healthy subjects …”