Reflux micro-aspiration associated with oesophageal dysmotility but not delayed liquid gastric emptying

Abstract

<b>Introduction:</b> Severe ineffective oesophageal motility (IOM) is associated with treatment resistant reflux and pulmonary reflux micro-aspiration. The role of delayed liquid gastric emptying (LGE) in the pathophysiology of severe reflux disease remains unknown. The purpose of this study is to examine the relationship between delayed LGE, reflux micro-aspiration and&nbsp;IOM. <b>Methods:</b> Data was extracted from a prospectively populated database of patients with severe treatment resistant gastro-oesophageal reflux disease (GORD). All patients with new technique reflux aspiration scintigraphy (RASP) and oesophageal manometry were included in the analysis. Patients were highly selected treatment refractory cases and classified by predominant clinical subtype as gastro-oesophageal (GOR) or laryngo-pharyngeal (LPR) reflux. LGE half-time of 22 minutes or longer was considered delayed. <b>Results:</b> Inclusion criteria were met by 631 patients (61% female; average age 56, SD 15, range 14-88). Normal LGE half-time was found in 450 patients, whilst 181 had evidence of delayed LGE. Mean liquid half-clearance was 22.81min. Pulmonary aspiration was a common event (38%). Difference in the aspiration rates between delayed LGE (42%) and normal LGE (36%) was not significant (p=0.16). Severe IOM was independent of LGE time (p=0.987) but was strongly associated with reflux micro-aspiration (P&lt;0.001). GOR dominant symptoms were more common in patients with delayed LGE (p=0.03). <b>Conclusion:</b> Severe IOM is strongly associated with reflux aspiration. Delayed LGE is not associated with reflux aspiration or severe IOM. Delayed LGE is more prevalent in patients presenting with GOR dominant symptoms.