Ineffective esophageal motility and gastroesophageal reflux disease: A close relationship?

Ergün, Meltem; Doğan, İbrahim; Ünal, Selahattin

doi:10.4318/tjg.2012.0452

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Ho et al [15] reported that IEM was found in 49.4% of GERD patients. Ergün et al [16] also reported that all variables for gastroesophageal reflux were higher in patients with IEM than in those with NEM. Furthermore, Kahrilas et al [27] reported that IEM was more prevalent in patients with more advanced reflux disease.…”

Section: Discussionmentioning

confidence: 99%

“…Ineffective esophageal motility (IEM) is the most common gastrointestinal motility disorder [13] and is defined as ineffective swallowing (distal contractile integral of <450 mm Hg/cm/s) during more than 50% of swallowing attempts [14]. Some studies have suggested that IEM is the most common motility disorder in GERD [15,16]. Conversely, other studies have shown no relationship between IEM and GERD [17,18].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

et al. 2017

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Background/Aims: Ineffective esophageal motility (IEM) is the most common gastrointestinal motility disorder. Studies have reported that IEM is related to gastroesophageal reflux disease (GERD). However, the relationship between IEM and GERD remains uncertain. This study aims to clarify this relationship retrospectively. Methods: We analyzed 195 subjects who underwent high-resolution manometry between January 2011 and September 2016. Of these subjects, 72 had normal esophageal motility (NEM) and 26 had IEM. We investigated differences in the clinical characteristics, severity and duration of GERD symptoms, and comorbid extra-esophageal symptoms of the subjects. Comorbid extra-esophageal symptoms were assessed with the Gastrointestinal Symptom Rating Scale questionnaire. Investigation-defined GERD was diagnosed when erosive esophagitis or abnormal multichannel intraluminal impedance was present. Results: We found no significant difference in the prevalence of IEM between patients with and without GERD (37.5 and 21.1%, respectively; p = 0.174). There were no differences in age, gender, body mass index, presence of hiatal hernia, or duration of GERD between the groups. Compared to patients with NEM, those with IEM were significantly less likely to have comorbid extra-esophageal symptoms (p < 0.05). Conclusion: There is no association between IEM and GERD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

et al. 2017

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“…There is much suggestion in the literature that IEM is associated with coexisting gastroesophageal reflux disease (GERD), but causality or interaction of the two conditions still remains unknown. 2, 7, 8, 9, 10, 11, 12, 13, 14 On the other hand, there are studies that show different results even though their data do not disprove some association between GERD and IEM, but rather declare that IEM is not standing alone as a cause of GERD. 15, 16, 17 Other hypotheses suggest an association with rapid food intake, 18, 19 Vagal hyper-reactivity, 20 advanced age, 21, 22 or damage to the enteric nervous system or smooth muscle 16 as possible etiologies.…”

Section: Introductionmentioning

confidence: 95%

Manometric Subtypes of Ineffective Esophageal Motility

Hiestand

Jalil

Castell

2017

Clinical and Translational Gastroenterology

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Objectives:Ineffective esophageal motility (IEM) is characterized by well-defined manometric criteria. However, much variation exists within the diagnosis: Some patients exhibit exactly the required five weak swallows to make the diagnosis. Others show consistently ineffective swallows with total absence of any normal swallow. “We hypothesize” there are two different manometric subtypes of IEM; IEM Alternans (IEM-A) and IEM Persistens (IEM-P).Methods:A total of 231 IEM patients were identified by high-resolution manometry (HRM). IEM defined by distal contractile integral (DCI) <450 mm Hg/s/cm in ≥50% of test swallows. Abnormal reflux study was defined by excess total number of reflux episodes, abnormal esophageal acid exposure, or positive symptom association.Results:A total of 195 (84%) patients had IEM-A and 36 (16%) had IEM-P. A striking gender difference with 34% of IEM-A being males compared to 53% of IEM-P. (P=0.03). Mean age of IEM-P (59.6 years+/−13.1) was greater than IEM-A (55.5 years+/−13.6) (P=0.04). Mean lower esophageal sphincter (LES) resting pressure was significantly lower in IEM-P (20.8 mm Hg+/−1.4) than IEM-A (29 mm Hg+/−1.2) (P=0.002). There was no difference in LES-integrated relaxation pressure (IRP), bolus transit, or manometric presence of hiatal hernia between the two groups. Out of 146, 89 (61%) patients had abnormal reflux study. Esophageal acid exposure in upright position was significantly higher in IEM-P than IEM-A (3.5 vs. 1.7%, P=0.04). Poor gastric acid control on proton pump inhibitor (PPI) was more prevalent among IEM-P patients (58%) than IEM-A (27%) (P=0.007). In subgroup analysis of 41 IEM patients with dysphagia, DCI for liquid swallows was significantly lower in IEM-P (111+/−142 mm Hg/s/cm) compared to IEM-A (421+/−502 mm Hg/s/cm) (P=0.04), lower mean LES resting pressure in IEM-P (16.6+/−9 mm Hg) than IEM-A (31.7+/−18 mm Hg) (P=0.01).Conclusions:There are two distinct manometric IEM subtypes; IEM-P with an older male predominance, more advanced reflux disease, weaker LES, and worse response to PPI; likely a more advanced manifestation than IEM-A. However, the question if there are different etiologies underlying the two subtypes remains to be answered.

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“…Increased transient lower esophageal sphincter relaxation (TLESR), hypotensive lower esophageal sphincter (LES) or diaphragmatic crural dysfunction, anatomical defects in the esophagogastric junction (EGJ), ineffective esophageal motility (IEM), abnormal esophageal bolus transport, and abnormal responses to multiple rapid swallowing (MRS) are closely associated with GERD. [2][3][4][5] Recently, new techniques to detect esophageal functional defects, such as 24-hour pH and multichannel intraluminal impedance (MII) monitoring, MII and esophageal manometry (MII-EM), high-resolution manometry (HRM), 3-dimensional HRM, enoscopic functional luminal imaging probe (EndoFLIP), and 24-hour dynamic esophageal manometry have improved our understanding of the pathogenesis of GERD and provided the basis for developing comprehensive and effective treatment programs. In this article, we reviewed recent advances in our understanding of esophageal motility dysfunction in GERD and discussed GERD therapeutic perspectives.…”

Section: Introductionmentioning

confidence: 99%

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

Lin

Fang

2019

J Neurogastroenterol Motil

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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.

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Ineffective esophageal motility and gastroesophageal reflux disease: A close relationship?

Abstract: Girifl ve Amaç: ‹nefektif özofageal motilite ile gastroözofageal reflü hastal›¤› aras›ndaki iliflki daha önceki baz› çal›flmalarda gös-terilmifltir, ancak halen baz› karfl›t görüfller de mevcuttur. Biz Gazi Üniversitesi Gastroenteroloji

Cited by 7 publications

References 28 publications

The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

Manometric Subtypes of Ineffective Esophageal Motility

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

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