The Relevance of Ineffective Esophageal Motility to Surgical Practice

2021 ◽  
Vol 1 (3) ◽  
pp. 250-253
Author(s):  
Geoffrey P. Kohn
Keyword(s):  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Esophagogastric Junction ◽  
Postoperative Dysphagia ◽  
Treatment Protocols ◽  
Surgical Practice ◽  
Ineffective Esophageal Motility ◽  
Foregut Surgery ◽  
Provocation Testing ◽  
Dysphagia Outcomes

Foregut surgery is often complicated by postoperative dysphagia. Preoperative esophageal manometry has been used to counsel patients and to guide choice of operation to minimize dysphagia outcomes. Uncertainty surrounds the optimal surgical management of patients with disordered motility. While treatment protocols are generally accepted for the disorders of esophagogastric junction outflow, surgery choice in the presence of disorders of peristalsis, particularly ineffective esophageal motility (IEM), is less clear. With the diagnosis of IEM, provocation testing is being utilized to predict postoperative dysphagia and to guide management, though evidence is not yet sufficient to allow for strong recommendations.

Ineffective Esophageal Motility: Need for Improvement in Diagnostic Criteria

2021 ◽  
Vol 1 (3) ◽  
pp. 244-249
Author(s):  
Joan W. Chen
Keyword(s):  
Diagnostic Criteria ◽  
Esophageal Motility ◽  
Ineffective Esophageal Motility ◽  
Esophageal Clearance ◽  
Diagnostic Threshold ◽  
Prospective Trials ◽  
Esophageal Sphincter ◽  
Provocation Testing ◽  
Asymptomatic Subjects ◽  
Conclusive Diagnosis

Ineffective esophageal motility (IEM) is a hypomotility disorder with decreased contraction vigor and normally relaxing lower esophageal sphincter. Although IEM has been associated with poor esophageal clearance and gastroesophageal reflux, it is also seen in asymptomatic subjects and is often of unclear clinical significance. The Chicago classification version 4.0 updated the diagnostic threshold to require >70% weak or fragmented swallows or ≥50% failed swallows for a conclusive diagnosis of IEM. Provocation testing are recommended in borderline cases to assess clinical relevance. Prospective trials are needed to further refine the diagnostic criteria, understand the pathophysiology, and develop an effective treatment for IEM.

scholarly journals The Effect of Diet Composition Change on High-Resolution Oesophageal Manometry Metrics in Non-Erosive Gastroesophageal Reflux Disease Patients

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 54-54
Author(s):  
Sergey Morozov ◽  
Vasily Isakov
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Diet Composition ◽  
Control Group ◽  
Study Group ◽  
Ineffective Esophageal Motility ◽  
Dietary Fiber Intake ◽  
Significant Difference ◽  
Resting Pressure

Abstract Objectives To evaluate the influence of change of diet composition on esophageal manometry metrics. Methods The data of 43 NERD patients with low (<20 g/day) baseline dietary fiber intake served as a source data. These patients were examined with the use of standard food frequency questionnaire and high-resolution esophageal manometry. Thirty of them received psyllium 5.0 g TID 10 days in addition of their usual diet within registered clinical trial (NCT01882088). The other 13 were found in the database by diagnosis; their data were eligible in case of the presence of repeated high-resolution esophageal manometry examination and dietary assessments at the same time point and if no significant change in diet composition was revealed. The changes were assessed in accordance to Chicago classification 3.0. Non-parametric statistics (Wilcoxon matched pairs test, Mann-Whitney U-test) were used to assess the change in HRM metrics in these groups. Results In those who received psyllium, significant increase of minimal lower esophageal resting pressure at rest and after 10 water swallows was registered: 5.41 ± 10.1 vs 11.3 ± 9.4 mm Hg, P = 0.023 and 14.1 ± 8.0 vs 14.9 ± 6.4 mm Hg, P = 0.008, accordingly. No significant difference was found in the group with no change of diet composition by these parameters. At baseline, ineffective esophageal motility was found in 46.7% patients of the study group and 53.8% in the control group (P = 0.7). Esophageal motility became normal in 71.4% of those who had IEM initially in the study group after 10 days of treatment, and in 14.3% among the controls (P = 0.0135). This type of peristaltic abnormality was found not changed in 28.6% of the study group and in 85.7% among the control group, P = 0.014. New cases of ineffective esophageal motility revealed in 12.5% of the study group and 16.7% among the controls (P = 0.8) Conclusions Change of diet composition by additional quantity of psyllium may result in the improvement of esophageal motility. Funding Sources Federal Research Center of Nutrition and Biotechnology.

scholarly journals A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

2016 ◽  
Vol 14 (3) ◽  
pp. 439-442 ◽  
Author(s):  
Fernando Augusto Herbella ◽  
Priscila Rodrigues Armijo ◽  
Marco Giuseppe Patti
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Chicago Classification ◽  
Esophageal Spasm ◽  
Pictorial Presentation

ABSTRACT High resolution manometry changed several esophageal motility paradigms. The 3.0 Chicago Classification defined manometric criteria for named esophageal motility disorders. We present a pictorial atlas of motility disorders. Achalasia types, esophagogastric junction obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus (jackhammer), ineffective esophageal motility, and fragmented peristalsis are depicted with high-resolution manometry plots.

Rheumatologic disorders in patients undergoing esophageal manometry: prevalence, symptom characteristics, and manometric findings

2021 ◽  
Author(s):  
Anam Qureshi ◽  
Asad Jehangir ◽  
Zubair Malik ◽  
Henry P Parkman
Keyword(s):  
Lupus Erythematosus ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Upper Esophageal Sphincter ◽  
Motility Disorders ◽  
Ineffective Esophageal Motility ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Esophageal Sphincter ◽  
Esophageal Contractility

Summary Rheumatologic disorders (RDs) can have gastrointestinal (GI) manifestations. Systemic sclerosis (SSc) patients often have upper GI symptoms from absent esophageal contractility (AC). Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RDs have not been well studied. We aimed to: (i) determine the prevalence of RD in patients undergoing HREMI and (ii) assess the symptom characteristics and manometric findings of these patients. Patients undergoing HREMI (July 2018 to March 2020) rated their GI symptoms’ severity. Healthy volunteers (HVs) also underwent HREMI. Of the 1,003 patients, 90 (9%) had RD (mean age: 55.3 ± 1.4 years, 73.3% females), most commonly SSc (n = 27), rheumatoid arthritis (RA, n = 20), and systemic lupus erythematosus (SLE, n = 11). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia, with no significant differences in their severities between SSc, RA, and SLE. RD patients had higher upper esophageal sphincter (UES) pressures, lower distal contractile integral (DCI), lower bolus clearance, and more frequent hiatal hernia (HH) on HREMI (all P < 0.05) than HVs. Over half (61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n = 25), ineffective esophageal motility (IEM; n = 18), and esophagogastric junction (EGJ) obstructive disorders (n = 11). Among patients undergoing HREMI, 9% had RD. Upper GI symptom severities did not distinguish different RDs. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH than HVs. Although AC and IEM were most common motility disorders, a considerable minority (12.2%) of our RD patients had EGJ obstructive disorders.

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

2003 ◽  
Vol 124 (4) ◽  
pp. A54
Author(s):  
Magnus Simren ◽  
Jiri Silny ◽  
Richard H. Holloway ◽  
Jan Tack ◽  
Jozef Janssens ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Ineffective Esophageal Motility ◽  
Acid Clearance ◽  
Esophageal Acid Clearance
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