Assessment of Esophageal Motility Disorders in Patients With Refractory Gastroesophageal Reflux Disease
,
Abstract
There is insufficient data about esophageal body dysmotility in patients with refractory gastroesophageal reflux disease (RGERD) and inadequate response to proton pump inhibitors (PPIs) treatment. This study aimed to assess esophageal motility disorder and reflux parameters among these patients by high-resolution manometry (HRM) and intraluminal impedance and pH (MII‐pH) monitoring after stopping PPI therapy. A retrospective study was conducted among 100 RGERD patients admitted to Taleghani Hospital (Tehran, Iran) for one year. More than half of them were males (55%). Their mean age was 47.10±6.92, and 50% of patients had ineffective esophageal motility (IEM). Middle, distal, and proximal esophageal pressure (MEP, DEP, and PEP), lower esophageal sphincter (LES) basal pressure (LESP), integrated relaxation pressure (IRP), distal contractile integral (DCI), large breaks, upper esophageal sphincter basal pressure (UESP), and LES length (LESL) in IEM patients were significantly lower than the patients with normal esophageal motility (P<0.001). Furthermore, there were more patients in the IEM group with long-term and abnormal weakly acid reflux compared with the non-IEM group (P<0.05). It seems that the evaluation of reflux parameters and esophageal motility could lead to additional insights into the pathophysiological mechanisms of RGERD. Nevertheless, further studies are suggested to evaluate the effects of esophageal motility disorders among RGERD patients.
1. Chatila AT, Nguyen MTT, Krill T, Roark R, Bilal M, Reep G. Natural history, pathophysiology and evaluation of gastroesophageal reflux disease. Dis Mon. 2020;66(1):100848.
2. Mohammad S, Channa BC, Soomro AA, Lakho S, Ali Z, Soomro ZA, Shaukat F. Depression and anxiety in patients with gastroesophageal reflux disorder with and without Chest Pain. Cureus. 2019;11(11).
3. Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R. The changing epidemiology of gastroesophageal reflux disease: are patients getting younger? Neurogastroenterol Motil. 2018;24(4):559.
4. Tack J, Becher A, Mulligan C, Johnson D. Systematic review: the burden of disruptive gastro‐oesophageal reflux disease on health‐related quality of life. Aliment Pharmacol Ther. 2012;35(11):1257-66.
5. Strand DS, Kim D, Peura DA. 25 years of proton pump inhibitors: a comprehensive review. Gut Liver. 2017;11(1):27.
6. Mermelstein J, Mermelstein AC, Chait MM. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions. Clin Exp Gastroenterol. 2018; 11:119.
7. Kunsch S, Neesse A, Linhart T, Nell C, Gress T, Ellenrieder V. Prospective evaluation of duodenogastroesophageal reflux in gastroesophageal reflux disease patients refractory to proton pump inhibitor therapy. Digestion. 2012;86(4):315-22.
8. Scarpellini E, Ang D, Pauwels A, De Santis A, Vanuytsel T, Tack J. Management of refractory typical GERD symptoms. Nat Rev Gastroentrol Hepatol. 2016;13(5):281-94.
9. Zerbib F, Sifrim D, Tutuian R, Attwood S, Lundell L. Modern medical and surgical management of difficult-to-treat GORD. United Eur Gastroenterol J. 2013;1(1):21-31.
10. Lin S, Li H, Fang X. Esophageal motor dysfunctions in gastroesophageal reflux disease and therapeutic perspectives. J Neurogastroenterol Motil. 2019;25(4):499.
11. Cho YK, Choi M-G, Lim CH, Kim JS, Park JM, Lee IS, et al. Impaired esophageal bolus transit in patients with gastroesophageal reflux disease and abnormal esophageal acid exposure. Gut Liver. 2012;6(4):440.
12. Ang D, Blondeau K, Sifrim D, Tack J. The spectrum of motor function abnormalities in gastroesophageal reflux disease and Barrett’s esophagus. Digestion. 2009;79(3):158-68.
13. Jiang L, Ye B, Wang Y, Wang M, Lin L. Esophageal body motility for clinical assessment in patients with refractory gastroesophageal reflux symptoms. J Neurogastroenterol Motil. 2017;23(1):64.
14. Van Hoeij FB, Bredenoord AJ. Clinical application of esophageal high-resolution manometry in the diagnosis of esophageal motility disorders. J Neurogastroenterol Motil. 2016;22(1):6.
15. Pandolfino JE. High-resolution manometry: is it better for detecting esophageal disease? Gastroenterol Hepatol. 2010;6(10):632-634.
16. Vardar R, Keskin M. Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease? 2017. Turk J Gastroenterol; 28 (Suppl 1): S16-S21.
17. Shaw MJ, Talley NJ, Beebe TJ, Rockwood T, Carlsson R, Adlis S, Fendrick AM, Jones R, Dent J, Bytzer P. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(1):52-7.
18. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012;61(9):1340-54.
19. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche J, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111(1):85-92.
20. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3. 0. Neurogastroenterol Motil. 2015;27(2):160-74.
21. Cho YK. How to interpret esophageal impedance pH monitoring. J Neurogastroenterol Motil. 2010;16(3):327.
22. Ozin Y, Dagli U, Kuran S, Sahin B. Manometric findings in patients with isolated distal gastroesophageal reflux. World J Gastroenterol. 2009;15(43):5461.
23. Sifrim D, Castell D, Dent J, Kahrilas P. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53(7):1024-31.
24. Tenca A, Campagnola P, Bravi I, Benini L, Sifrim D, Penagini R. Impedance pH monitoring: intra-observer and inter-observer agreement and usefulness of a rapid analysis of symptom reflux association. J Neurogastroenterol Motil. 2014;20(2):205.
25. Reddy CA, Baker JR, Lau J, Chen JW. High-resolution manometry diagnosis of ineffective esophageal motility is associated with higher reflux burden. Dig Dis Sci. 2019;64(8):2199-205.
26. Jandee S, Geeraerts A, Geysen H, Rommel N, Tack J, Vanuytsel T. Management of Ineffective Esophageal Hypomotility. Front Pharmacol. 2021; 12:1311.
27. Shetler K, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30(6).
28. Clarrett DM, Hachem C. Gastroesophageal reflux disease (GERD). Mo Med. 2018;115(3):214.
29. Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP. Advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol. 2017;14(11):665-76.
30. Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5(3):260-5.
31. Herregods T, Troelstra M, Weijenborg PW, Bredenoord AJ, Smout A. Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterol Motil. 2015;27(9):1267-73.
32. Takeshima F, Hashiguchi K, Onitsuka Y, Tanigawa K, Minami H, Matsushima K, Akazawa Y, Shiozawa K, Yamaguchi N, Taura N, Ohnita K. Clinical characteristics of patients with gastroesophageal reflux disease refractory to proton pump inhibitors and the effects of switching to 20 mg esomeprazole on reflux symptoms and quality of life. Med Sci Mon Int Med J Exp Clin Res. 2015; 21:4111.
33. Chen CL, Yi CH, Liu TT. Relevance of ineffective esophageal motility to secondary peristalsis in patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2014;29(2):296-300.
34. Wang VS, Feldman N, Maurer R, Burakoff R. Esophageal motility in nonacid reflux compared with acid reflux. Dig Dis Sci. 2009;54(9):1926-32.
35. Rengarajan A, Bolkhir A, Gor P, Wang D, Munigala S, Gyawali C. Esophagogastric junction and esophageal body contraction metrics on high‐resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30(5): e13267.
36. Munitiz V, Ortiz A, Martinez de Haro L, Molina J, Parrilla P. Ineffective oesophageal motility does not affect the clinical outcome of open Nissen fundoplication. J Br Surg. 2004;91(8):1010-4.
37. Martinucci I, De Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther. 2014;5(2):86.
38. Blonski W, Vela M, Safder A, Hila A, Castell DO. Revised criterion for diagnosis of ineffective esophageal motility is associated with more frequent dysphagia and greater bolus transit abnormalities. Am J Gastroenterol. 2008;103(3):699-704.
39. Sandhu A, Eisa M, Yamasaki T, Shibli F, Fass R. Durability of esophageal motor disorders identified on high-resolution esophageal manometry: A Case Series. Adv Ther. 2020;37(5):2560-71.
2. Mohammad S, Channa BC, Soomro AA, Lakho S, Ali Z, Soomro ZA, Shaukat F. Depression and anxiety in patients with gastroesophageal reflux disorder with and without Chest Pain. Cureus. 2019;11(11).
3. Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R. The changing epidemiology of gastroesophageal reflux disease: are patients getting younger? Neurogastroenterol Motil. 2018;24(4):559.
4. Tack J, Becher A, Mulligan C, Johnson D. Systematic review: the burden of disruptive gastro‐oesophageal reflux disease on health‐related quality of life. Aliment Pharmacol Ther. 2012;35(11):1257-66.
5. Strand DS, Kim D, Peura DA. 25 years of proton pump inhibitors: a comprehensive review. Gut Liver. 2017;11(1):27.
6. Mermelstein J, Mermelstein AC, Chait MM. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions. Clin Exp Gastroenterol. 2018; 11:119.
7. Kunsch S, Neesse A, Linhart T, Nell C, Gress T, Ellenrieder V. Prospective evaluation of duodenogastroesophageal reflux in gastroesophageal reflux disease patients refractory to proton pump inhibitor therapy. Digestion. 2012;86(4):315-22.
8. Scarpellini E, Ang D, Pauwels A, De Santis A, Vanuytsel T, Tack J. Management of refractory typical GERD symptoms. Nat Rev Gastroentrol Hepatol. 2016;13(5):281-94.
9. Zerbib F, Sifrim D, Tutuian R, Attwood S, Lundell L. Modern medical and surgical management of difficult-to-treat GORD. United Eur Gastroenterol J. 2013;1(1):21-31.
10. Lin S, Li H, Fang X. Esophageal motor dysfunctions in gastroesophageal reflux disease and therapeutic perspectives. J Neurogastroenterol Motil. 2019;25(4):499.
11. Cho YK, Choi M-G, Lim CH, Kim JS, Park JM, Lee IS, et al. Impaired esophageal bolus transit in patients with gastroesophageal reflux disease and abnormal esophageal acid exposure. Gut Liver. 2012;6(4):440.
12. Ang D, Blondeau K, Sifrim D, Tack J. The spectrum of motor function abnormalities in gastroesophageal reflux disease and Barrett’s esophagus. Digestion. 2009;79(3):158-68.
13. Jiang L, Ye B, Wang Y, Wang M, Lin L. Esophageal body motility for clinical assessment in patients with refractory gastroesophageal reflux symptoms. J Neurogastroenterol Motil. 2017;23(1):64.
14. Van Hoeij FB, Bredenoord AJ. Clinical application of esophageal high-resolution manometry in the diagnosis of esophageal motility disorders. J Neurogastroenterol Motil. 2016;22(1):6.
15. Pandolfino JE. High-resolution manometry: is it better for detecting esophageal disease? Gastroenterol Hepatol. 2010;6(10):632-634.
16. Vardar R, Keskin M. Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease? 2017. Turk J Gastroenterol; 28 (Suppl 1): S16-S21.
17. Shaw MJ, Talley NJ, Beebe TJ, Rockwood T, Carlsson R, Adlis S, Fendrick AM, Jones R, Dent J, Bytzer P. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(1):52-7.
18. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012;61(9):1340-54.
19. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche J, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111(1):85-92.
20. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3. 0. Neurogastroenterol Motil. 2015;27(2):160-74.
21. Cho YK. How to interpret esophageal impedance pH monitoring. J Neurogastroenterol Motil. 2010;16(3):327.
22. Ozin Y, Dagli U, Kuran S, Sahin B. Manometric findings in patients with isolated distal gastroesophageal reflux. World J Gastroenterol. 2009;15(43):5461.
23. Sifrim D, Castell D, Dent J, Kahrilas P. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53(7):1024-31.
24. Tenca A, Campagnola P, Bravi I, Benini L, Sifrim D, Penagini R. Impedance pH monitoring: intra-observer and inter-observer agreement and usefulness of a rapid analysis of symptom reflux association. J Neurogastroenterol Motil. 2014;20(2):205.
25. Reddy CA, Baker JR, Lau J, Chen JW. High-resolution manometry diagnosis of ineffective esophageal motility is associated with higher reflux burden. Dig Dis Sci. 2019;64(8):2199-205.
26. Jandee S, Geeraerts A, Geysen H, Rommel N, Tack J, Vanuytsel T. Management of Ineffective Esophageal Hypomotility. Front Pharmacol. 2021; 12:1311.
27. Shetler K, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30(6).
28. Clarrett DM, Hachem C. Gastroesophageal reflux disease (GERD). Mo Med. 2018;115(3):214.
29. Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP. Advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol. 2017;14(11):665-76.
30. Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5(3):260-5.
31. Herregods T, Troelstra M, Weijenborg PW, Bredenoord AJ, Smout A. Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterol Motil. 2015;27(9):1267-73.
32. Takeshima F, Hashiguchi K, Onitsuka Y, Tanigawa K, Minami H, Matsushima K, Akazawa Y, Shiozawa K, Yamaguchi N, Taura N, Ohnita K. Clinical characteristics of patients with gastroesophageal reflux disease refractory to proton pump inhibitors and the effects of switching to 20 mg esomeprazole on reflux symptoms and quality of life. Med Sci Mon Int Med J Exp Clin Res. 2015; 21:4111.
33. Chen CL, Yi CH, Liu TT. Relevance of ineffective esophageal motility to secondary peristalsis in patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2014;29(2):296-300.
34. Wang VS, Feldman N, Maurer R, Burakoff R. Esophageal motility in nonacid reflux compared with acid reflux. Dig Dis Sci. 2009;54(9):1926-32.
35. Rengarajan A, Bolkhir A, Gor P, Wang D, Munigala S, Gyawali C. Esophagogastric junction and esophageal body contraction metrics on high‐resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30(5): e13267.
36. Munitiz V, Ortiz A, Martinez de Haro L, Molina J, Parrilla P. Ineffective oesophageal motility does not affect the clinical outcome of open Nissen fundoplication. J Br Surg. 2004;91(8):1010-4.
37. Martinucci I, De Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther. 2014;5(2):86.
38. Blonski W, Vela M, Safder A, Hila A, Castell DO. Revised criterion for diagnosis of ineffective esophageal motility is associated with more frequent dysphagia and greater bolus transit abnormalities. Am J Gastroenterol. 2008;103(3):699-704.
39. Sandhu A, Eisa M, Yamasaki T, Shibli F, Fass R. Durability of esophageal motor disorders identified on high-resolution esophageal manometry: A Case Series. Adv Ther. 2020;37(5):2560-71.
| Files | ||
| Issue | Vol 60 No 10 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v60i10.11552 | |
| Keywords | ||
| : Refractory gastroesophageal reflux disease (RGERD) High-resolution manometry (HRM) Multichannel intraluminal impedance-pH (MII-Ph) monitoring Ineffective esophageal motility (IEM) Esophageal motility | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bagherzadeh A, Abdi S, Zali MR, Mohammadi S. Assessment of Esophageal Motility Disorders in Patients With Refractory Gastroesophageal Reflux Disease. Acta Med Iran. 2022;60(10):616-621.
