Ineffective Esophageal Motility in Gastroesophageal Erosive Reflux Disease and in Nonerosive Reflux Disease

Abstract

In GERD patients, ineffective esophageal motility (IEM), a hypocontractile disorder, is the most common motor abnormality. IEM has been associated with reflux in both the supine and upright position, prolonged esophageal clearance, and delayed of bolus transport. IEM has been equally present in erosive and in nonerosive GERD. Considering that reflux has been found to be more severe in erosive GERD than in nonerosive GERD patients and that IEM delays esophageal clearance, our hypothesis is that patients with erosive GERD have more severe IEM than those with nonerosive disease. A retrospective review of consecutive manometries of patients with the chief complaint of heartburn and a diagnosis of IEM were performed, and patients with both erosive and nonerosive GERD were selected. According to the number of ineffective contractions, IEM was stratified into three groups: 30% to 40%, mild; 50% to 60%, moderate; and greater than 60%, severe. We also registered the number of low amplitude, failed, and normal waves in each manometry of both groups. We evaluated 110 patients: 70 (64%) with erosive GERD and 40 (36%) with nonerosive GERD. The percentage of mild, moderate and severe IEM was similar in erosive and in nonerosive GERD patients, as well the number of low amplitude, failed or normal waves (P < 0.5). There were no differences between the severity of IEM in erosive and in nonerosive GERD patients.