Relevance of ineffective esophageal motility (IEM) during esophageal acid clearance

Abstract The aim of the study was to evaluate the influence of change in diet composition on high-resolution esophageal manometry (HRM) patterns. Methods The data of 43 NERD patients with low (<20 g/day) dietary fibre intake served as a source data. These patients were examined with the use of standard food frequency questionnaire and HRM. Thirty of them received psyllium 5.0 G TID 10 days additionally to their usual diet (NCT01882088). Control group was formed by the database search for patients who had repeated HRM examinations and dietary assessments at the same time point and if no significant change in diet composition was revealed. HRM assessment was in accordance to Chicago-3.0. Non-parametric statistics were used to assess the change in HRM metrics. Results Minimal LES resting pressure at rest and after 10 water swallows increased in study group: 5.41 ± 10.1 vs 11.3 ± 9.4 mmHg, P = 0.023 and 14.1 ± 8.0 vs 14.9 ± 6.4 mmHg, P = 0.008. No difference was found in those whose diet composition was stable. Ineffective esophageal motility initially was found in 46.7% patients of the study group and 53.8% in the control group (P = 0.7). IEM resolved in 71.4% of the study group, and in 14.3% of controls (P = 0.0135). IEM not changed in 28.6% of the study group and in 85.7% of controls, P = 0.014. New IEM revealed in 12.5% of the study group and 16.7% among the controls (P = 0.13). Conclusion Change of diet composition by additional quantity of dietary fibre (psyllium) to the standard rations may result in the improvement of esophageal motility.

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P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

Diseases of the Esophagus ◽

10.1093/dote/doz092.173 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Carlo Galdino Riva ◽

Stefano Siboni ◽

Veronica Lazzari ◽

Marco Sozzi ◽

Emanuele Asti ◽

...

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Symptom Relief ◽

Rank Test ◽

Barium Swallow ◽

Upper Gastrointestinal Endoscopy ◽

Magnetic Sphincter Augmentation ◽

Hrql Score ◽

High Resolution Manometry ◽

Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

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