Role of Mixed Reflux and Hypomotility with Delayed Reflux Clearance in Patients with Non-cardiac Chest Pain

Abstract

Background/AimsGastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (NCCP). Currently available data reveal a weak relationship between NCCP and dysmotility. Moreover, it is unclear why some refluxes are perceived as heartburn and others as NCCP. We aimed to evaluate the role of the reflux pattern and the esophageal motility in patients with NCCP. MethodsForty-eight patients with NCCP (Group 1) and 50 only typical GERD symptoms (Group 2) were included and underwent highresolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring. ResultsImpaired peristalsis was found in 60% of patients with NCCP and in 24% of patients with typical symptoms (P < 0.05). In patients belonging to Group 1, the majority of reflux episodes associated with chest pain were acid and mixed. The proportion of mixed refluxes was higher than that in Group 2. In Group 1, the reflux clearing time at 5, 9, and 15 cm, measured in reflux episodes associated to NCCP was longer than in reflux episodes associated to typical symptoms (mean ± 95% CI: 27.2 ± 5.6, 23.3 ± 4.4, and 14.6 ± 2.3 seconds vs 18.3 ± 3.5, 13.3 ± 2.2, and 11.1 ± 1.8 seconds; P < 0.01). ConclusionsThe presence of gas in the refluxate seems to be associated with NCCP. The impaired motility observed in NCCP patients may play a relevant role in delaying reflux clearing, hence increasing the time of contact between refluxate and esophageal mucosa.

Classification of esophageal motor findings in gastro‐esophageal reflux disease: Conclusions from an international consensus group

“…The likelihood of a normal HRM study is less when esophageal reflux burden is high, and even lower when erosive esophagitis or Barrett's esophagus are diagnosed . The most common abnormal pattern in GERD is hypomotility, of the esophageal body, the LES, or both .…”

Comparison of esophageal motility in gastroesophageal reflux disease with and without globus sensation

“…For those who were resistant to PPI therapy, Tsutsui et al (8) reported a prevalence of abnormal esophageal motility of 47.9%. However, in the study by Ribolsi et al (9), only 24% of patients with typical GERD symptoms demonstrated esophageal dysmotility. In our study, the prevalence of esophageal dysmotility in the globus GERD group was 33.3% and 23.3% in the typical GERD group.…”

“…Esophageal dysmotility may also contribute to GERD. Previous studies have shown a higher frequency of esophageal dysmotility in GERD with globus rather than GERD with typical symptoms (7)(8)(9). High-resolution manometry (HRM) is a useful tool in evaluating esophageal motility (10) and this study aimed to compare the esophageal motility between GERD patients with and without globus symptoms.…”

High-resolution Manometry Findings During Solid Swallows Correlate With Delayed Reflux Clearance and Acid Exposure Time in Non-erosive Reflux Disease Patients

“…It has been demonstrated that HRM is a novel, promising technique that might be helpful in understanding the relationship between the esophageal motor parameters and GERD. 8,9,[21][22][23] The study herewith presented is hampered by some limitations. The small population of patients enrolled does not allow consideration of these conclusions as definitive.…”