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 ENDOSCOPIC EVALUATION OF MANOMETRIC PROFILE OF GASTRO ESOPHAGEAL REFLUX DISEASE

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Radhey Shyam Gupta
Keyword(s):  
Lower Esophageal Sphincter ◽  
Reflux Disease ◽  
Esophageal Motility ◽  
Study Participant ◽  
Lower Esophageal Sphincter Pressure ◽  
P Value ◽  
Sphincter Pressure ◽  
Esophageal Reflux ◽  
Ineffective Esophageal Motility ◽  
Esophageal Sphincter

Background: Gastro esophageal reflux disease leads to poor quality of life to patients because of pain and discomfort. Some studies also reported that incidence of adenocarcinoma of esophagus and Barrett's esophagus among patients with reflux disease. The abnormal esophageal motility act as a major risk factors and also reported with severity and prognosis of the disease. Material & Methods: In present study 50 patients of heart burn or acid regurgitation (GERD) for at least more than 3 months were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results:  15 (30%) had non-erosive reflux disease and 35 (70%) had erosive reflux disease. Among the patients of non-erosive reflux disease, 13 (26%) had normal lower esophageal sphincter pressure and 2 (4%) had Low Lower esophageal sphincter pressure. Among the patients of erosive reflux disease, 32 (64%) had normal lower esophageal sphincter pressure and 3 (6%) had Low Lower esophageal sphincter pressure (P value >0.05). Among the patients of non-erosive reflux disease, 10 (20%) had normal esophageal motility and 5 (10%) had Ineffective esophageal motility. Among the patients of erosive reflux disease, 25 (50%) had normal esophageal motility and 10 (20%) had Ineffective esophageal motility (P value >0.05). Conclusion: Low Lower esophageal sphincter and Ineffective or abnormal esophageal motility pressure was non-significantly associated with non-erosive and erosive reflux disease. Ineffective esophageal motility and Low LES pressure was the main cause for gastro esophageal reflux disease Keywords: GERD, High Resolution Manometry, Ineffective peristalsis.

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.

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

Sa161 INEFFECTIVE ESOPHAGEAL MOTILITY: CAN SEVERITY PREDICT GERD?

2021 ◽  
Vol 160 (6) ◽  
pp. S-444-S-445
Author(s):  
Meenakshi Krishna ◽  
Ofer Fass ◽  
Abraham Khan ◽  
Rita M. Knotts
Keyword(s):  
Esophageal Motility ◽  
Ineffective Esophageal Motility

scholarly journals THE PARTICIPATION OF THE NITRERGIC PATHWAY IN INCREASED RATE OF TRANSITORY RELAXATION OF LOWER ESOPHAGEAL SPHINCTER INDUCED BY RECTAL DISTENSION IN DOGS

2014 ◽  
Vol 51 (2) ◽  
pp. 102-106 ◽  
Author(s):  
Michel Santos PALHETA ◽  
José Ronaldo Vasconcelos da GRAÇA ◽  
Armênio Aguiar dos SANTOS ◽  
Liziane Hermógenes LOPES ◽  
Raimundo Campos PALHETA JÚNIOR ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Control Group ◽  
Rectal Distension ◽  
Evaluation Protocol ◽  
Lower Esophageal Sphincter Relaxation ◽  
Respective Control Group ◽  
Esophageal Sphincter ◽  
Pre Treatment

ContextThe rectal distension in dogs increases the rate of transitory lower esophageal sphincter relaxation considered the main factor causing gastroesophageal reflux.ObjectivesThe aim of this study was evaluate the participation of the nitrergic pathway in the increased transitory lower esophageal sphincter relaxation rate induced by rectal distension in anesthetized dogs.MethodsMale mongrel dogs (n = 21), weighing 10-15 kg, were fasted for 12 hours, with water ad libitum. Thereafter, they were anesthetized (ketamine 10 mg.Kg-1+ xylazine 20 mg.Kg-1), so as to carry out the esophageal motility evaluation protocol during 120 min. After a 30-minute basal period, the animals were randomly intravenous treated whith: saline solution 0.15M (1ml.Kg-1), L-NAME (3 mg.Kg-1), L-NAME (3 mg.Kg-1) + L-Arginine (200 mg.Kg-1), glibenclamide (1 mg.Kg-1) or methylene blue (3 mg.Kg-1). Forty-five min after these pre-treatments, the rectum was distended (rectal distension, 5 mL.Kg-1) or not (control) with a latex balloon, with changes in the esophageal motility recorded over 45 min. Data were analyzed using ANOVA followed by Student Newman-Keuls test.ResultsIn comparison to the respective control group, rectal distension induces an increase in transitory lower esophageal sphincter relaxation. Pre-treatment with L-NAME or methylene blue prevents (P<0.05) this phenomenon, which is reversible by L-Arginine plus L-NAME. However, pretreating with glibenclamide failed to abolish this process.ConclusionsTherefore, these experiments suggested, that rectal distension increases transitory lower esophageal sphincter relaxation in dogs via through nitrergic pathways.

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