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Impaired motility in Barrett's esophagus: A study using high‐resolution manometry with physiologic challenge
Author(s) -
Sanagapalli S.,
Emmanuel A.,
Leong R.,
Kerr S.,
Lovat L.,
Haidry R.,
Banks M.,
Graham D.,
Raeburn A.,
ZarateLopez N.,
Sweis R.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13330
Subject(s) - medicine , high resolution manometry , reflux , gastroenterology , esophagus , heartburn , endoscopy , contractility , ambulatory , esophageal motility disorder , disease
Abstract Background Esophageal dysmotility may predispose to Barrett's esophagus ( BE ). We hypothesized that high‐resolution manometry ( HRM ) performed with additional physiologic challenge would better delineate dysmotility in BE . Methods Included patients had typical reflux symptoms and underwent endoscopy, HRM with single water swallows and adjunctive testing with solids and rapid drink challenge ( RDC ) before ambulatory pH ‐impedance monitoring. BE and endoscopy‐negative reflux disease ( ENRD ) subjects were compared against functional heartburn patient‐controls ( FHC ). Primary outcome was incidence of HRM contractile abnormalities with standard and adjunctive swallows. Secondary outcomes included clearance measures and symptom association on pH ‐impedance. Key Results Seventy‐eight patients ( BE 25, ENRD 27, FHC 26) were included. Water swallow contractility was reduced in both BE (median DCI 87 mm Hg/cm/s) and ENRD (442 mm Hg/cm/s) compared to FHC (602 mm Hg/cm/s; P < .001 and .04, respectively). With the challenge of solid swallows and RDC , these parameters improved in ENRD (solids = 1732 mm Hg/cm/s), becoming similar to FHC (1242 mm Hg/cm/s; P = .93), whereas abnormalities persisted in BE (818 mm Hg/cm/s; P < .01 c.f. FHC ). In BE and ENRD , reflux events (67 vs 57 events/24 hour) and symptom frequency were similar; yet symptom correlation was significantly better in ENRD compared to BE , which was comparable to FHC (symptom index 30% vs 4% vs 0%, respectively). Furthermore, bolus clearance and exposure times were more pronounced in BE ( P < .01). Conclusions & Inferences Reduced contractile effectiveness persisted in BE with the more representative esophageal challenge of swallowing solids and free drinking; while in ENRD and FHC peristalsis usually improved, demonstrating peristaltic reserve. Furthermore, symptom association and refluxate clearance were reduced in BE . These factors may underlie BE pathogenesis.