Relevance of mild ineffective oesophageal motility (IOM) and potential pharmacological reversibility of severe IOM in patients with gastro‐oesophageal reflux disease

Abstract

SUMMARY BackgroundSeveral studies showed high prevalence of ineffective oesophageal motility (IOM) in gastro-oesophageal reflux disease (GERD) and suggested an important role for ineffective oesophageal motility in increased acid exposure. However, impedance-manometric studies proposed that only severe ineffective oesophageal motility might affect oesophageal clearance.

Gastroesophageal Reflux Disease is Inversely Related with Glycemic Control in Morbidly Obese Patients

“…Esophageal peristalsis and LES pressure were both stronger in patients with worst GC. It is known that peristaltic response acts to protect the esophagus after reflux, participating in the process of esophageal clearance [43,44]. Resting LES pressure also may contribute to avoid episodes of straining related reflux, particularly in obese patients [45].…”

Rapid air infusion into the oesophagus: Motor response in patients with achalasia and nonobstructive dysphagia assessed with high‐resolution manometry

“…Previous studies have suggested that, in NOD patients with ineffective motility, neuromuscular structures are at least partially preserved and the main nerve damage is at the neural cholinergic stimulation level. 21,22 Our data have shown that a minority of patients have impaired triggering of distension-induced motor response and all of these patients had already evidence of severely altered motility when tested with water swallows. Similarly to what has been discussed with achalasia patients, this alteration could identify a subset of patients with different pathophysiological features, hypothesis to be addressed with a larger cohort of patients.…”

Diagnosis and medical management of esophageal dysmotility

“…In fact, several studies have suggested the potential for IEM reversal following treatment of erosive esophagitis [87,88]. For those patients with dysphagia as their primary complaint, limited evidence supports a potential role for cholinergic stimulation with medications such as bethanechol in IEM [76,89]. However, given the poor correlation between symptoms and these manometric findings, medical therapy aimed toward visceral sensation is often most appropriate.…”