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Ineffective Esophageal Motility Is Associated with Impaired Bolus Clearance but Does Not Correlate with Severity of Dysphagia

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Abstract

Background

Ineffective esophageal motility (IEM) is defined as a distal contractile integral < 450 mmHg/s/cm in at least 50% of ten liquid swallows on high-resolution esophageal manometry (HREM). Whether this latest definition correlates with degree of symptoms has not been studied.

Methods

Patients presenting for HREM prospectively rated their symptoms using the Eckardt score. Topography plots were retrospectively reviewed and classified according to the latest Chicago Classification. Patients with non-obstructive dysphagia and an Eckardt score of at least 1 were included. Patients with major motility disorders were excluded. Scores between patients with IEM (group A) and patients with normal classification (group B) were compared using two-tailed t-tests. Spearman’s correlation coefficient was calculated to determine correlation between symptoms and percent bolus clearance.

Results

A total of 241 patients were screened; 33 patients met criteria for group A and 44 patients for group B. There was no difference between the two groups in mean symptom severity for dysphagia (1.63 vs. 1.61, P = 0.89), chest pain (0.67 vs. 0.75, P = 0.64), regurgitation (1.06 vs. 0.85, P = 0.32), or weight loss (0.85 vs. 0.49, P = 0.11). The percent bolus clearance was significantly lower in group A (46.5% vs. 76.7%, P > 0.01). There was a moderate inverse correlation between dysphagia and percent bolus clearance (R = − 0.37) in group A, but none in group B (R = 0.09).

Conclusion

The classification of IEM did not discriminate from normal studies for symptom severity in our cohort. However, patients with IEM did have an inverse correlation between dysphagia score and bolus clearance, but those without IEM did not. Adding impedance information to the motor pattern classification should be considered in the symptom assessment in minor motility disorders.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Road, Skyline 2N-D08, Valhalla, NY, 10595, USA

    Priyanka Chugh & Brad Dworkin

  2. Division of Digestive and Liver Diseases, Department of Medicine, Stony Brook School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA

    Tyson Collazo

  3. Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, Suite 862, New York, NY, 10032, USA

    Daniela Jodorkovsky

Authors
  1. Priyanka Chugh
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  2. Tyson Collazo
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  3. Brad Dworkin
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  4. Daniela Jodorkovsky
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Correspondence to Priyanka Chugh.

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All authors declare that they do not have conflict of interest.

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Chugh, P., Collazo, T., Dworkin, B. et al. Ineffective Esophageal Motility Is Associated with Impaired Bolus Clearance but Does Not Correlate with Severity of Dysphagia. Dig Dis Sci 64, 811–814 (2019). https://doi.org/10.1007/s10620-018-5384-x

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  • DOI: https://doi.org/10.1007/s10620-018-5384-x

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