J Neurogastroenterol Motil.  2019 Jan;25(1):68-74. 10.5056/jnm18054.

High-resolution Manometry Findings During Solid Swallows Correlate With Delayed Reflux Clearance and Acid Exposure Time in Non-erosive Reflux Disease Patients

Affiliations
  • 1Unit of Digestive Disease, Campus Bio Medico University of Rome, Italy. m.ribolsi@unicampus.it

Abstract

BACKGROUND/AIMS
The role of esophageal motility in determining gastroesophageal reflux disease (GERD) severity has not been completely evaluated. A few studies have investigated high-resolution manometry (HRM) patterns during solid swallows. The present study evaluates the HRM patterns of non-erosive reflux disease (NERD) patients during both liquid and solid swallows and their correlation with the severity of GERD.
METHODS
In 23 NERD patients and 15 healthy volunteers (HVs) HRM was performed during a standard solid meal in a seated position, followed by 24-hour impedance-pH monitoring.
RESULTS
Of the 31 patients, 10 showed a pathological acid exposure time (AET; NERD patients), 13 a normal pH profile with positive symptom association probability (SAP; reflux hypersensitivity patients), and 8 normal AET and SAP (functional heartburn patients). Mean distal contractile integral and distal latency values, in all patient groups and HVs, were significantly higher during solid swallows. In the group of 10 NERD patients, the number of large breaks of the esophageal peristalsis was 16 out of 100 liquid swallows (16%) and 31 out of 171 solid swallows (18%). Fourteen out of 100 liquid swallows (14%) and 25 out of 171 solid swallows (15%) resulted ineffective. Mean reflux clearing time at multichannel intraluminal impedance-pH was 17.6 ± 3.7 seconds. NERD patients presented, during solid swallows, a significantly higher proportion of large peristaltic breaks and of ineffective swallows than reflux hypersensitivity and functional heartburn patients.
CONCLUSION
HRM during solid swallows reveals motor abnormalities, undetected during liquid swallows, which might be involved in delaying reflux and acid clearance in patients with GERD.

Keyword

Esophageal sphincter, lower; Gastroesophageal reflux; Manometry; Peristalsis; Swallows

MeSH Terms

beta-Aminoethyl Isothiourea
Esophageal Sphincter, Lower
Gastroesophageal Reflux
Healthy Volunteers
Heartburn
Humans
Hydrogen-Ion Concentration
Hypersensitivity
Manometry*
Meals
Peristalsis
Posture
Swallows*
beta-Aminoethyl Isothiourea
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