Esophageal Motor Disorders Are a Strong and Independant Associated Factor of Barrett's Esophagus

Abstract

Background/AimsEsophageal motor disorder (EMD) has been shown to be associated with gastroesophageal reflux disease (GERD). However, the association of EMD with a Barrett’s esophagus (BE) is controversial. Our objective was to evaluate whether the presence of EMD was an independent factor associated with BE.MethodsA retrospective case-control study was conducted in GERD patients who all had oeso-gastroduodenal endoscopy and high-resolution esophageal manometry. The clinical data collected was known or potential risk factors for BE: male gender, smoking and alcohol consumption, age, body mass index, presence of hiatal hernia, frequency, and age of GERD. EMD were classified according to the Chicago classification into: ineffective motor syndrome, fragmented peristalsis and absence of peristalsis, lower esophageal sphincter hypotonia.ResultsTwo hundred and one patients (101 in the GERD + BE group and 100 in the GERD without BE) were included. In univariate analysis, male gender, alcohol consumption, presence of hiatal hernia, and EMD appeared to be associated with the presence of BE. In a multivariate analysis, 3 independent factors were identified: the presence of EMD (odds ratio [OR], 3.99; 95% confidence interval [CI], 1.71–9.28; P = 0.001), the presence of hiatal hernia (OR, 5.60; 95% CI, 2.45–12.76; P < 0.001), Helicobacter pylori infection (OR, 0.08; 95% CI, 0.01–0.84; P = 0.035).ConclusionsThe presence of EMD (particularly ineffective motor syndrome and lower esophageal sphincter hypotonia) is a strong independent associated factor of BE. Searching systematically for an EMD in patients suffering from GERD could be a new strategy to organize the endoscopic follow-up.

Endoscopic pressure study integrated system reflects gastroesophageal junction competence in patients with erosive esophagitis and Barrett´s esophagus

“…Iwakiri et al 11 revealed that lower basal LES pressure was observed among patients with BE. Bazin et al 12 also showed that lower resting LES pressure was strongly associated with BE. Leeuwenburgh et al concluded that LES‐lowering therapy for achalasia should be considered a risk factor for the development of BE 13.…”

“…The LES function affects the pathogenesis of BE since this abnormal condition is thought to be the outgrowth of reflux esophagitis, which has a strong relationship with TLESRs. However, few studies have investigated the association between BE and LES function 11,12,13. In our previous pilot report, the results of EPSIS were well correlated with acid reflux monitored by 24‐hour pH‐monitoring, suggesting EPSIS can reflect LES function 10.…”

Barrett’s Esophagus in Romania: what do we know?

“…Considering the role of manometry in the screening of the BE, there are studies showing that the presence of esophageal motor disorder is a strong independent associated factor of BE and that searching for motor disorders in patients suffering from GERD could be a new strategy to organize the endoscopic follow-up [32].…”

Precision care for Barrett’s esophagus

“…A retrospective case-control study on GERD patients undergoing endoscopy and high-resolution esophageal manometry, was performed in 201 patients (101 GERD with BE and 100 GERD without BE) to examine the role of esophageal dysmotility classified into: IEM, fragmented peristalsis and absence of peristalsis, and lower esophageal sphincter (LES) hypotonicity. In a multivariate analysis, the presence of EMD (OR 3.99; 95% CI, 1.71-9.28; P=0.001) particularly IEM and LES hypotonicity and hiatal hernia (OR 5.60; 95% CI, 2.45-12.76; P<0.001), were independently associated factors of BE (16). IEM contributes to poor esophageal clearance and increased esophageal acid and bile exposure particularly while supine and at night, leading to BE and possibly, its progression to dysplasia.…”