PWE-142 The reflux pathology in ineffective oesophageal motility

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Abstract

Introduction

Ineffective oesophageal motility (IOM) is considered as a minor oesophageal motility disorder without clear relevance to significant oesophageal diseases. IOM incorporates a composite of failed, weak and segmented peristalsis during water swallows. In this study we hypothesise that severe IOM has significant impact on patients’ health.

Method

Patients diagnosed with IOM based on Chicago Classification (CC)(version 3)1 between July 2017 to December 2017 were selected. All patients underwent high-resolution manometry (HRM) and 24 hour impedance-pH monitoring. Patients were classified into 2 groups based on distal contractile integral (DCI) outcome of swallows: group I with failed peristalsis >50% (DCI <100 Hgscm) and group II with weak peristalsis >50% (DCI ≥100–450 mmHgscm). Statistical t-test, χ2 test and odd ratio (OR) were used to compare reflux parameters and HRM findings between groups I and II.

Results

259 patients were found having reflux monitoring: group I (F:M≥59:32, age 20–83 years) and group II (F:M≥116:52, age 18–79 years). The acid exposure time was significantly higher in group I in the daytime (p≥0.037) and nocturnal periods (p≥0.006). The total pathological acid exposure was also significantly higher (p≥0.036, OR ≥1.75).

Results

The mean acid clearance time was significantly higher demonstrating poor clearance in group I (p≥0.011). The DeMeester score was significantly elevated in the group I (p≥0.009) and showed higher prevalence of abnormal DeMeester score (p≥0.01, OR ≥1.9). RDQ score between groups I and II were not statistically significant (2.2 vs 2.0, p≥0.190).

Results

Other findings of interest from HRM, in the total of 364 IOM patients, 65.9% patients dominantly had failed peristalsis (group I) and notably 69.2% IOM patients were female. Group I showed significantly higher prevalence of hypotensive LOS compared to group II (p<0.001, OR ≥2.11). There were no statistical differences in the incidence of hiatus hernia between the groups (OR ≥0.8, p≥0.415) nor in the hiatus hernia size (p≥0.118).

Conclusion

Two subset reflux pathology states exists in IOM and patients with dominantly failed peristalsis (group I) have greater prevalence of pathological reflux exposure and having incompetent antireflux barrier. Based on this study, a great number of patients with IOM should not be considered as having a minor oesophageal disease and this needs to be reflected on the clinical management. Further investigation is required to investigate whether patients with dominantly failed peristalsis are at greater risk of developing oesophagitis and precancerous Barrett’s oesophagus.

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