Abstract
The relationship between esophageal motor abnormalities and GERD has been widely studied. The purpose of this study was to identify the prevalence of ineffective esophageal motility (IEM) in patients with GERD. In addition, we also evaluated esophageal acid exposure, acid clearance, and endoscopic esophagitis in GERD patients with IEM. Of 89 patients enrolled in this study, 47 (52.8%) were found to have nonspecific esophageal motility disorder (NEMD). Forty-four of the 47 (93.6%) patients with NEMD met the diagnostic criteria for IEM. The overall incidence of IEM in GERD patients was 49.4%. Patients with IEM had significant increases in upright and recumbent mean fraction of time pH < 4 (6.70% and 4.38%) and mean recumbent esophageal acid clearance (12.45 min/reflux) when compared to those with other motility findings. Seventeen of the 44 (39%) IEM patients did not have endoscopic esophagitis. On the other hand, 26 of the 39 (67%) patients with normal manometry had endoscopic esophagitis. We concluded that not only is the prevalence of IEM high in GERD, but also that IEM patients have more recumbent gastroesophageal reflux and delayed acid clearance. Combined with endoscopic findings, we propose that IEM can be viewed as a specific entity of primary esophageal motility disorder in patients with GERD.
Similar content being viewed by others
REFERENCE
Kahrilas PJ: Gastroesophageal reflux disease. JAMA 276:983–988, 1996
Huang JQ, Hunt RH: pH, healing rate, and symptom relief in patients with GERD. Yale J Biol Med 72:181–194, 1999
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A: Esophageal peristaltic dysfunction in peptic esophagitis. Gastroentology 91:897–904, 1986
Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS: Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552, 1982
Dent J: Recent views on the pathogenesis of gastro-esophageal reflux disease. Baillieres Clin Gastroenterol 1:727–745, 1987
Kahrilas PJ, Dodds WJ, Hogan WJ: Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94:73–80, 1998
Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy volunteers. Variability of pressure with age frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987
Katzka DA: Motility abnormalities in gastroesophageal reflux disease. Gastroenterol Clin North Am 28:905–915, 1999
Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO: Ineffective esophageal motility (IEM): The primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci 42:1859–1865, 1997
Burns TW, Venturatos SG: Esophageal motor function and response to acid perfusion in patients with symptomatic reflux esophagitis. Dig Dis Sci 30:529–532, 1985
Allen ML, McIntosh DL, Robinson MG: Healing or amelioration of esophagitis does not result in increased lower esophageal sphincter or esophageal contractile pressure. Am J Gastroenterol 85:1331–1334, 1990
McClave SA, Boyce HW Jr, Gottfried MR: Early diagnosis of columnar-lined esophagus: A new endoscopic criterion. Gastrointest Endosc 33:413–416, 1987
Tytgat GNJ, Hameeteman W, Onstenk R, Schotborg R: The spectrum of columnar-linked esophagus—Barrett's esophagus. Endoscopy 21:177–185, 1989
Nandurkar S, Talley NJ: Barrett's esophagus: The long and the short of it. Am J Gastroenterol 94:30–40, 1999
Spechler SJ: Complications of gastroesophageal reflux disease. In The Esophagus, 2nd ed. DO Castell (ed). Boston, Little, Brown, and Company, 1997, pp 533–546
Chang CS, Poon SK, Lien HC, Chen GH: The incidence of reflux esophagitis among the Chinese. Am J Gastroenterol 92:668–671, 1997
Ho KY, Kang JY: Prevalence of gastrointestinal symptoms in a multi-racial Asian population, with particular reference to re-flux-type symptoms. Am J Gastroenterol 93:1816–1822, 1998
Williams D, Thompson DG, Heggie L, O'Hanrahan T, Bancewicz J: Esophageal clearance function following treatment of esophagitis. Gastroenterology 106:108–116, 1994
Eriksen CA, Sadek SA, Cranford C, Sutton D, Kennedy N, Cuscheieri A: Reflux oesophagitis and oesophageal transit: Evidence for a primary oesophageal motor disorder. Gut 29:448–452, 1998
Timmer R, Breumelhof R, Nadorp JH, Smout AJ: Esophageal motor response to reflux is not impaired in reflux esophagitis. Gut 34:317–320, 1993
Ho KY, Kang JY: Reflux esophagitis Patients in Singapore: Have motor and acid exposure abnormalities similar to patients in the western hemisphere. Am J Gastroenterol 94:1186–1191, 1999
Horbach JM, Masclee AA, Lamers CB, Gooszen HG: A prospective study on the effect of the Belsey Mark IV 270-degree fundoplication on lower esophageal sphincter characteristics and esophageal body motility. J Thorac Cardivasc Surg 109:636–641, 1995
Eckardt VF: Does healing of esophagitis improve esophageal motor function? Dig Dis Sci 33:161–165, 1998
Howard JM, Reynolds RP, Frei JV, Flowers MA, McDonald TJ, Tilbe K, Bondy DC: Macroscopic healing of esophagitis does not improve esophageal motility. Dig Dis Sci 39:648–654, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ho, SC., Chang, CS., Wu, CY. et al. Ineffective Esophageal Motility Is a Primary Motility Disorder in Gastroesophageal Reflux Disease. Dig Dis Sci 47, 652–656 (2002). https://doi.org/10.1023/A:1017992808762
Issue Date:
DOI: https://doi.org/10.1023/A:1017992808762