J Neurogastroenterol Motil.  2019 Oct;25(4):499-507. 10.5056/jnm19081.

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

Affiliations
  • 1Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. fangxiucai2@aliyun.com
  • 2Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China.

Abstract

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.

Keyword

Esophageal motility disorders; Esophagogastric junction; Gastroesophageal reflux; Manometry; Pharmaceutical preparations

MeSH Terms

Deglutition
Electric Impedance
Esophageal Motility Disorders
Esophageal Sphincter, Lower
Esophagogastric Junction
Esophagus
Gastroesophageal Reflux*
Gastrointestinal Contents
Hernia, Hiatal
Humans
Hydrogen-Ion Concentration
Hypersensitivity
Manometry
Mucous Membrane
Peristalsis
Pharmaceutical Preparations
Phenobarbital
Prevalence
Proton Pump Inhibitors
Relaxation
Upper Gastrointestinal Tract
Pharmaceutical Preparations
Phenobarbital
Proton Pump Inhibitors
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