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Relevance of ineffective esophageal motility to secondary peristalsis in patients with gastroesophageal reflux disease
Author(s) -
Chen ChienLin,
Yi ChihHsun,
Liu TsoTsai
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12367
Subject(s) - peristalsis , abnormality , medicine , motility , gastroenterology , esophagus , esophageal motility disorder , reflux , achalasia , disease , biology , genetics , psychiatry
Background and Aims The study aimed to investigate the hypothesis whether the presence of Ineffective esophageal motility would affect physiological characteristics of secondary peristalsis. Methods Secondary peristalsis was performed with slow and rapid air injections into mid‐esophagus of 18 ineffective esophageal motility patients and 15 age‐matched controls. Severity of ineffective esophageal motility was defined by the application of combined multichannel intraluminal impedance and manometry. Results Ineffective esophageal motility patients included 11 patients without impedance abnormality and seven patients with impedance abnormality during liquid and/or viscous swallowing. The prevalence of failed secondary peristaltic response during slow air injection was significantly greater in ineffective esophageal motility patients without impedance abnormality (3/11 [27%], P < 0.001) and with impedance abnormality (4/7 [57%], P = 0.04) than healthy subjects. The threshold volume for inducing secondary peristalsis during rapid air injection was significantly greater in ineffective esophageal motility patients with impedance abnormality (6.1 ± 0.3 m L ) than healthy subjects (4.6 ± 0.3 m L , P < 0.05) and ineffective esophageal motility patients without impedance abnormality (4.1 ± 0.4 m L , P < 0.05). The frequency of peristaltic response during rapid air injection was significantly lower in ineffective esophageal motility patients with impedance abnormality (40% [20–50%] than healthy subjects (90% [90–100%], P < 0.05). Conclusions Defective activation of secondary peristalsis is present in ineffective esophageal motility patients with impedance abnormality. Our study indicates that increased ineffective esophageal motility severity associated with defective triggering of secondary peristalsis may contribute to impaired esophageal clearance in patients with gastroesophageal reflux disease.