Tu1782 Weak Peristalsis With Large Breaks Is Associated With Higher Acid Exposure and Delayed Reflux Clearance in the Supine Position in GERD Patients

Abstract

INTRODUCTION It has been demonstrated that among esophageal motor abnormalities, impaired peristalsis of the esophageal body may account for delayed bolus transit and impaired esophageal refl ux clearance in patients with complicated gastroesophageal refl ux disease (GERD) ( 1,2 ). In particular, several studies have shown that ineffective esophageal motility (IEM), defi ned as the presence of peristaltic waves at the distal esophagus with amplitude < 30 mm Hg and / or nontransmitted proximal contractions, is frequently observed in GERD patients; however, the functional relevance remains controversial ( 3 ). In GERD patients, increasing degrees of esophageal mucosal damage have been reported either to cause, or be the result of, severe worsening of esophageal function ( 4,5 ). Nevertheless, even if IEM has been associated with prolonged acid exposure time (AET) ( 6 ), it has been demonstrated that in GERD patients, only severe, but not mild IEM, is associated with prolonged clearance and AET, particularly when in the supine position ( 7 ). Th e recent development of high-resolution manometry (HRM) has led to an improvement of our knowledge regarding esophageal motility and is considered the gold standard in the study of esophageal motor disorders ( 8 ). Indeed, HRM combined with multichannel impedance (HRM-MI) monitoring allows simultaneous recording and analysis of the esophageal motility and of the bolus transit. Fox et al. ( 9 )demonstrated, using HRM coupled with videofl uoroscopy, that HRM pressure topography plots predict bolus transit more accurately than conventional manometry. Moreover, these authors reported that, as a consequence of the increased spatial resolution, HRM is also able to detect segmental breaks of the esophageal peristalsis that would otherwise have been missed with conventional manometry. More recently, Bulsiewicz et al. ( 10 ) showed in healthy subjects and in patients with nonobstructive dysphagia that peristaltic breaks of < 2 cm in the 20 mm Hg or < 3 cm in the 30 mm Hg isobaric contour are associated with complete bolus clearance, whereas larger breaks predict delayed bolus clearance. Moreover, it has been proposed that weak peristalsis could be defi ned Weak Peristalsis With Large Breaks Is Associated With Higher Acid Exposure and Delayed Refl ux Clearance in the Supine Position in GERD Patients