Esophageal Dysmotility in Patients with Gastroesophageal Reflux Disease

Abstract

Introduction: Gastroesophageal reflux disease (GERD) poses a spectrum of disorders characterized by heartburn and regurgitation. Diagnosis involves clinical assessments and Proton Pump Inhibitor (PPI) trials, but 24-hour pH impedance monitoring is the gold standard for objective evidence. Key diagnostic parameters include acid exposure time (AET) and nonacid bolus reflux episodes during impedance. GERD complications encompass reflux esophagitis, Barrett’s esophagus, ulcers, hemorrhage, and peptic strictures. Notably, Ineffective Esophageal Motility (IEM) is linked to GERD, creating a cyclical relationship. This study aims to explore the correlation between esophageal dysmotility and GERD, shedding light on the controversial relationship. Materials and Methods: This is a retrospective observational study Conducted from October 2010 to December 2021, which included 168 patients undergoing 24-hour pH impedance monitoring on and off PPI. Data collection involved clinical details and High-Resolution Manometry (HRM) findings. GERD was defined using the Demeester score and bolus reflux episodes, while IEM was diagnosed according to the Chicago 4.0 classification. The prevalence of IEM was compared between patients with and without GERD. Results:  Among the 168 patients (mean age: 44 years, 58.9% males, 41.1% females), 53.6% were on PPI during monitoring. IEM was present in 19% of patients, and objective evidence of GERD was found in 45.23%. Heartburn was significantly associated with GERD (67.1%). However, there was no statistically significant difference in regurgitation, chest pain, and extraesophageal symptoms between patients with and without GERD. IEM occurred in 22.4% of patients with GERD and 16.3% without, with no significant correlation (P=.316). Conclusion: This study did not find a significant correlation between IEM and GERD. Nevertheless, these findings warrant validation through prospective studies to contribute to a comprehensive understanding of the relationship between esophageal dysmotility and GERD.