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High-Resolution Manometry Diagnosis of Ineffective Esophageal Motility Is Associated with Higher Reflux Burden

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Abstract

Introduction

Ineffective esophageal motility (IEM) is the most commonly diagnosed abnormality on high-resolution manometry (HRM). However, the clinical significance of IEM and associated reflux burden remains unclear.

Aim

Our primary aim was to compare reflux patterns between IEM versus normal motility on HRM.

Methods

HRM and reflux studies in patients with IEM and normal motility were retrospectively reviewed. Esophageal pressure topography parameters, reflux variables, and patient-reported outcome questionnaires were explored.

Results

A total of 239 patients with IEM were explored. Of these, 146 underwent reflux monitoring. Additionally, 100 patients with normal HRM all of whom had undergone reflux monitoring were included. IEM patients were more likely to have an abnormal number of reflux events compared to normal (22.7% vs. 9.0%, p < 0.01). Including only off-proton pump inhibitor (PPI) testing, IEM patients had higher mean total acid exposure time (AET) and total reflux events compared to normal motility (p = 0.02). Within IEM patients, higher AET modestly correlated with increased percentage of impaired swallows. Increased reflux events modestly correlated with higher impaired swallows and decreased lower esophageal sphincter (LES) resting pressure. Reflux burden increased with higher esophagogastric junction (EGJ) subtype, driven mostly by subtype III, although there was no difference in the distribution of EGJ subtypes between the IEM and normal HRM cohorts.

Conclusions

Patients with HRM diagnosis of IEM may be more prone to acid reflux while off-PPI and non-acid reflux while on-PPI. Reflux burden appears to be worse in IEM patients who have lower resting LES pressure, higher EGJ subtype, or higher percentage of impaired swallows.

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Abbreviations

AET:

Acid exposure time

BMI:

Body Mass Index

CLT:

Conventional line tracing

CD:

Crural diaphragm

DCI:

Distal contractile integral

EPT:

Esophageal pressure topography

EGJ-CI:

Esophagogastric junction contractile integral

GERD:

Gastroesophageal reflux disease

HRM:

High-resolution manometry

HRIM:

High-resolution impedance manometry

IRB:

Institutional review board

IRP:

Integrated relaxation pressure

LES:

Lower esophageal sphincter

MII-pH:

Multichannel intraluminal impedance-pH

PPI:

Proton pump inhibitor

TLESR:

Transient lower esophageal sphincter relaxation

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Authors and Affiliations

  1. Division of Gastroenterology, University of Michigan Hospitals-Michigan Medicine, 3912 Taubman Center, 1500 E Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109, USA

    Chanakyaram A. Reddy, Jason R. Baker, Joyee Lau & Joan W. Chen

Authors
  1. Chanakyaram A. Reddy
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  2. Jason R. Baker
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  3. Joyee Lau
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  4. Joan W. Chen
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Contributions

CAR was involved in study planning, collection and analysis of data, interpretation of the data, and drafting of manuscript. JRB collected the data, interpreted the data, and edited the manuscript. JL planned the study, interpreted the data, and edited the manuscript. JWC was involved in study planning, interpretation of data, editing and approval of final manuscript. All authors have approved the submitted final draft.

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Correspondence to Chanakyaram A. Reddy.

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Reddy, C.A., Baker, J.R., Lau, J. et al. High-Resolution Manometry Diagnosis of Ineffective Esophageal Motility Is Associated with Higher Reflux Burden. Dig Dis Sci 64, 2199–2205 (2019). https://doi.org/10.1007/s10620-019-05633-3

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  • DOI: https://doi.org/10.1007/s10620-019-05633-3

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