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Ineffective esophageal motility and bolus clearance. A study with combined high‐resolution manometry and impedance in asymptomatic controls and patients
Author(s) -
Zerbib Frank,
Marin Ingrid,
Cisternas Daniel,
Abrahao Luiz,
Hani Albis,
Leguizamo Ana M.,
RemesTroche José M.,
Perez de la Serna Julio,
Ruiz de Leon Antonio,
Serra Jordi
Publication year - 2020
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.13876
Subject(s) - bolus (digestion) , medicine , asymptomatic , high resolution manometry , gastroenterology , motility , cohort , cardiology , peristalsis , esophagus , achalasia , biology , genetics
Background The definition and relevance of ineffective esophageal motility (IEM) remains debated. Our aim was to determine motility patterns and symptoms associated with IEM defined as impaired bolus clearance. Methods To define altered bolus clearance, normal range of swallows with complete bolus transit (CBT) on high‐resolution impedance manometry (HRIM) was determined in 44 asymptomatic controls. The results were then applied to a cohort of 81 patients with esophageal symptoms to determine the motility patterns which best predicted altered bolus clearance. Subsequently, in a cohort of 281 consecutive patients the identified motility patterns were compared with patients’ customary symptoms. Key Results In asymptomatic controls, the normal range of swallows with CBT was 50%‐100%. In patients, altered bolus transit (<50% CBT) was only associated with 30% or more failed contractions ( P < .001). Neither weak peristalsis nor absence of contraction reserve (CR) was associated with altered bolus clearance. The patterns which best predicted altered bolus clearance were failed contractions ≥30% (specificity 88.2% and sensitivity of 84.6%), and ≥70% ineffective (failed + weak) contractions (sensitivity 84.6% and specificity 80.9%). No motility pattern was correlated to symptom scores. Conclusions and Inferences Based on bolus clearance assessed by HRIM, ≥30% failed contractions and ≥70% ineffective contractions have the best sensitivity and specificity to predict altered bolus clearance. Weak contractions and absence of CR are not relevant with respect to bolus clearance.