Weak and absent peristalsis

Abstract

Background Weak and absent esophageal peristalsis are frequently encountered esophageal motility disorders, which may be associated with dysphagia and which may contribute to gastroesophageal reflux disease. Recently, rapid developments in the diagnostic armamentarium have taken place, in particular, in high-resolution manometry with or without concurrent intraluminal impedance monitoring. Purpose This article aims to review the current insights in the terminology, pathology, pathophysiology, clinical manifestations, diagnostic work-up,and management of weak and absent peristalsis.

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication

“…Thus the relation between pre-operative IEM and surgery outcome should be interpreted with caution. 15 Many patients with pre-operative minor disorders of peristalsis (impaired clearance) may actually benefit from Nissen fundoplication since the esophageal motility improves post-operatively, as it was demonstrated in this study. We believe that tailoring the operation to the degree of IEM is often not required to achieve a successful symptomatic and functional post-operative outcome.…”

“…IEM was previously reported by other researchers as the most prevalent esophageal motor disorder in GERD, found in 21-38% of patients in a large series, and its presence was associated with the severity of acid exposure and reflux symptoms. 15 Minor motility disorders that meet the criteria for IEM are probably the least studied manifestations of esophageal dysfunctions due to apparent lack of therapeutic options. There is no pharmacological treatment that reliably restores smooth muscle contractility and esophageal function.…”

“…There is no pharmacological treatment that reliably restores smooth muscle contractility and esophageal function. 15 Laparoscopic Nissen fundoplication is the most common surgery performed for GERD. The results of the studies on tailoring the degree of the operation (eg, complete Nissen wrap versus posterior Toupet wrap) to the esophageal motility pattern have inconclusive results.…”

“…On the other hand, one can find patients who complain of severe dysphagia but who have completely normal esophageal peristalsis and EGJ function. 15 The impact of fundoplication on esophageal motility and EGJ pressures and its clinical implications is very a sophisticated matter. In our study post-operative evaluation was performed relatively early after antireflux surgery, which may explain the high number of our patients who complained of dysphagia.…”

The Effect of Anti-reflux Therapy on Patients Diagnosed with Minor Disorders of Peristalsis in High-resolution Manometry

“…4 Another study revealed that the main presenting symptom was dysphagia in 65 patients with nonspecific esophageal motility disorders, 6 which may likely be associated with degeneration and atrophic changes in the layers of the esophageal smooth muscle. 16 One interesting study from Japan investigated the esophageal motility in patients with globus sensation who were refractory to PPI treatment. Out of the total of 119 patients who were refractory to PPI treatment, 47.9% had abnormal esophageal motility, of which 66.4% had IEM.…”