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Abstract
Background/Aims
Minor disorders of peristalsis are esophageal motility disorders categorized by the Chicago Classification (CC), version 3.0, which was announced in 2014. This study evaluated the efficacy of anti-reflux therapy in patients with minor peristaltic disorders.
Methods
Patients with minor peristaltic disorders in accordance with CC v3.0 were included. We reviewed the medical records of patients with esophageal high-resolution manometry findings, and investigated the demographic and clinical information as well as the medical therapy. Thereafter, the response to treatment was assessed after at least 4 weeks of treatment.
Results
A total of 24 patients were identified as having minor disorders of peristalsis from January 2010 to December 2015. The mean follow-up period was 497 days, and there were 17 patients (70.8%) patients with ineffective esophageal motility. In terms of anti-reflux therapy, proton pump inhibitors (PPIs) with prokinetic agents and PPIs alone were prescribed in 19 patients (79.2%) and 5 patients (20.8%), respectively. When the rate of response to the treatment was assessed, the responders rate (complete+sat-isfactory [≥50%] responses) was 54.2% and the non-responders rate (partial [<50%]+refractory responses) was 45.8%. Patients in the responder group were younger than those in the non-responder group (p=0.020). Among them, 13 patients underwent 24-hour multichannel intraluminal impedance-pH, and 10 patients (76.9%) were pathologic gastroesophageal reflux.
References
1. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009; 21:796–806.
2. Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012; 24(Suppl 1):57–65.
3. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015; 27:160–174.
4. Ribolsi M, Balestrieri P, Emerenziani S, Guarino MP, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014; 109:46–51.
5. Chen CL, Yi CH, Liu TT. Relevance of ineffective esophageal motility to secondary peristalsis in patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2014; 29:296–300.
6. Naftali T, Levit T, Pomeranz I, Benjaminov FS, Konikoff FM. Nonspecific esophageal motility disorders may be an early stage of a specific disorder, particularly achalasia. Dis Esophagus. 2009; 22:611–615.
7. Kimmel JN, Carlson DA, Hinchcliff M, et al. The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters. Neurogastroenterol Motil. 2016; 28:1157–1165.
8. Carlson DA, Crowell MD, Kimmel JN, et al. Loss of peristaltic reserve, determined by multiple rapid swallows, is the most frequent esophageal motility abnormality in patients with systemic sclerosis. Clin Gastroenterol Hepatol. 2016; 14:1502–1506.
9. Sánchez-Montalvá A, Moris M, Mego M, et al. High resolution esophageal manometry in patients with Chagas disease: a cross-sectional evaluation. PLoS Negl Trop Dis. 2016; 10:e0004416.
10. Ravi K, Friesen L, Issaka R, Kahrilas PJ, Pandolfino JE. Longterm outcomes of patients with normal or minor motor function abnormalities detected by high-resolution esophageal manometry. Clin Gastroenterol Hepatol. 2015; 13:1416–1423.
11. Maradey-Romero C, Gabbard S, Fass R. Treatment of esophageal motility disorders based on the chicago classification. Curr Treat Options Gastroenterol. 2014; 12:441–455.
12. Kim SE, Kim N, Oh S, et al. Predictive factors of response to proton pump inhibitors in korean patients with gastroesophageal reflux disease. J Neurogastroenterol Motil. 2015; 21:69–77.
13. Hyun JJ, Bak YT. Clinical significance of hiatal hernia. Gut Liver. 2011; 5:267–277.
14. Choi YJ, Park MI, Park SJ, et al. The effect of water bolus temperature on esophageal motor function as measured by high-resolution manometry. Neurogastroenterol Motil. 2014; 26:1628–1634.
15. Lee ES, Kim N, Lee SH, et al. Comparison of risk factors and clinical responses to proton pump inhibitors in patients with erosive oesophagitis and non-erosive reflux disease. Aliment Pharmacol Ther. 2009; 30:154–164.
16. Smout A, Fox M. Weak and absent peristalsis. Neurogastroenterol Motil. 2012; 24(Suppl 1):40–47.
17. Tsutsui H, Manabe N, Uno M, et al. Esophageal motor dysfunction plays a key role in GERD with globus sensation–analysis of factors promoting resistance to PPI therapy. Scand J Gastroenterol. 2012; 47:893–899.
18. Hendel L, Hage E, Hendel J, Stentoft P. Omeprazole in the long-term treatment of severe gastro-oesophageal reflux disease in patients with systemic sclerosis. Aliment Pharmacol Ther. 1992; 6:565–577.
19. Fukazawa K, Furuta K, Adachi K, et al. Effects of mosapride on esophageal motor activity and esophagogastric junction compliance in healthy volunteers. J Gastroenterol. 2014; 49:1307–1313.
20. Scarpellini E, Vos R, Blondeau K, et al. The effects of itopride on oesophageal motility and lower oesophageal sphincter function in man. Aliment Pharmacol Ther. 2011; 33:99–105.
21. Kang JW, Han DK, Kim ON, Lee KJ. Effect of DA-9701 on the normal motility and clonidine-induced hypomotility of the gastric antrum in rats. J Neurogastroenterol Motil. 2016; 22:304–309.
22. Oh KH, Nam Y, Jeong JH, Kim IK, Sohn UD. The effect of DA-9701 on 5-hydroxytryptamine-induced contraction of feline esophageal smooth muscle cells. Molecules. 2014; 19:5135–5149.
23. Sallam H, McNearney TA, Chen JD. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther. 2006; 23:691–712.
24. Min YW, Shin I, Son HJ, Rhee PL. Multiple rapid swallow maneuver enhances the clinical utility of high-resolution manometry in patients showing ineffective esophageal motility. Medicine (Baltimore). 2015; 94:e1669.
Table 1.
Baseline Characteristics in Patients with Minor Disorders of Peristalsis
| Patients (N=24) | IEM (n=17) | Fragmented peristalsis (n=7) | |
|---|---|---|---|
| Age (years, mean±SD) | 45.9±15.4 | 48.2±15.3 | 40.1±15.2 |
| Gender | |||
| Male (%) | 10 (41.7) | 8 (47.1) | 2 (28.6) |
| Female (%) | 14 (58.3) | 9 (52.9) | 5 (71.4) |
| BMI (kg/m2, mean±SD) | 23.0±2.5 | 22.7±2.2 | 23.6±3.0 |
| Cigarette smoking (%) | 5 (20.8) | 3 (17.6) | 2 (28.6) |
| Alcohol intake (%) | 7 (29.2) | 6 (35.3) | 1 (14.3) |
| Most bothersome symptom | |||
| Dysphagia (%) | 3 (12.5) | 2 (11.8) | 1 (14.3) |
| Chest discomfort (%) | 2 (8.3) | 2 (11.8) | 0 (0) |
| Throat discomfort (%) | 8 (33.3) | 5 (29.4) | 3 (42.9) |
| Epigastric discomfort (%) | 6 (25.0) | 5 (29.4) | 1 (14.3) |
| Acid regurgitation (%) | 4 (16.7) | 2 (11.8) | 2 (28.6) |
| Belching (%) | 1 (4.2) | 1 (5.9) | 0 (0) |
| Endoscopic findings | |||
| Reflux esophagitis | |||
| Normal (%) | 18 (75.0) | 12 (70.6) | 6 (85.7) |
| LA grade A (%) | 4 (16.7) | 3 (17.6) | 1 (14.3) |
| LA grade B (%) | 2 (8.3) | 2 (11.8) | 0 (0) |
| Hiatal hernia (%) | 6 (25.0) | 4 (23.5) | 2 (28.6) |
| Follow-up period (days) a | 497 (182, 30–2007) | 577 (305, 30–2007) | 241 (173, 61–839) |
| Therapeutic methods | |||
| PPI+Prokinetic agent (%) | 19 (79.2) | 14 (82.4) | 5 (71.4) |
| PPI alone (%) | 5 (20.8) | 3 (17.6) | 2 (28.6) |
Table 2.
Baseline HRM and 24-h MII/pH Metrics in Patients with Minor Disorders of Peristalsis
| Patients (N=24) | IEM (n=17) | Fragmented peristalsis (n=7) | p-value | |
|---|---|---|---|---|
| HRM metrics | ||||
| LES basal pressure (mmHg, mean±SD) | 14.1±6.5 | 13.6±6.1 | 15.6±7.8 | 0.500 |
| LES length (cm, mean±SD) | 2.9±0.4 | 2.8±0.3 | 3.1±0.5 | 0.230 |
| IRP (mmHg, mean±SD) | 5.5±4.2 | 5.8±3.5 | 5.0±5.7 | 0.671 |
| Effective swallows (%, mean±SD) | 46.1±28.9 | 47.2±31.1 | 43.3±24.5 | 0.768 |
| DCI (mmHg·s·cm, mean±SD) | 500.9±468.3 | 288.4±119.0 | 1017.0±603.5 | 0.019 b |
| EGJ morphology | 0.643 | |||
| EGJ type I, no hiatal hernia (%) | 14 (58.3) | 10 (58.8) | 4 (57.1) | |
| EGJ type II, small hiatal hernia (%) | 10 (41.7) | 7 (41.2) | 3 (42.9) | |
| EGJ type III, large hiatal hernia (%) | 0 (0) | 0 (0) | 0 (0) | |
| pH metrics a | ||||
| AET (%, mean±SD) | 1.8±2.4 | 1.4±1.9 | 2.7±3.3 | 0.347 |
| DeMeester score (mean±SD) | 7.2±8.3 | 6.0±7.1 | 9.9±11.3 | 0.461 |
| Impedance metrics a | ||||
| All reflux proximal episodes (mean±SD) | 21.5±11.9 | 20.4±13.8 | 24.0±6.7 | 0.640 |
| All reflux distal episodes (mean±SD) | 41.2±17.7 | 41.8±21.6 | 40.0±2.2 | 0.788 |
| Median bolus exposure time (sec, mean±SD) | 11.8±5.3 | 9.9±3.3 | 16.0±7.0 | 0.052 |
| All reflux percent time (%, mean±SD) | 1.2±0.8 | 1.9±1.0 | 1.1±0.3 | 0.759 |
| Pathologic GER a | 10/13 (76.9) | 7/9 (77.8) | 3/4 (75.0) | 0.706 |
HRM, high-resolution manometry; 24-h MII/pH, 24-hour multichannel intraluminal impedance-pH; IEM, ineffective esophageal motility; LES, lower esophageal sphincter; SD, standard deviation; IRP, integrated relaxation pressure; DCI, distal contractile integral; EGJ, esophagogastric junction; AET, acid exposure time; GER, gastroesophageal reflux.
Table 3.
Response to Treatment in the Patients with Minor Disorders of Peristalsis after Medical Therapy
| Patients (N=24) | IEM (n=17) | Fragmented peristalsis (n=7) | |
|---|---|---|---|
| Response to treatment | |||
| Complete (%) | 6 (25.0) | 3 (17.6) | 3 (42.9) |
| Satisfactory (%) | 7 (29.2) | 4 (23.5) | 3 (42.9) |
| Partial (%) | 8 (33.3) | 8 (47.1) | 0 (0) |
| Refractory (%) | 3 (12.5) | 2 (11.8) | 1 (14.3) |
| Response to treatment | |||
| Responders (%) a | 13 (54.2) | 7 (41.2) | 6 (85.7) |
| Non-responders (%) b | 11 (45.8) | 10 (58.8) | 1 (14.3) |
Table 4.
Comparison of Clinical Factors, HRM and 24-h MII/pH Metrics in Accordance with the Response to Treatment
| Responders (n = 13) | Non-responders (n = 11) | p-value | |
|---|---|---|---|
| Age (years, mean±SD) | 39.4±11.3 | 53.6±16.4 | 0.020 b |
| Female (%) | 8 (57.1) | 6 (42.9) | 1.000 |
| BMI (kg/m2, mean±SD) | 23.6±2.8 | 22.2±1.7 | 0.178 |
| Cigarette smoking (%) | 4 (80.0) | 1 (20.0) | 0.327 |
| Alcohol intake (%) | 5 (71.4) | 2 (28.6) | 0.386 |
| Most bothersome symptom | |||
| Dysphagia (%) | 0 (0) | 3 (100.0) | 0.082 |
| Chest discomfort (%) | 0 (0) | 2 (100.0) | 0.199 |
| Throat discomfort (%) | 4 (50.0) | 4 (50.0) | 1.000 |
| Epigastric discomfort (%) | 4 (66.7) | 2 (33.3) | 0.649 |
| Acid regurgitation (%) | 4 (100.0) | 0 (0) | 0.098 |
| Belching (%) | 1 (100.0) | 0 (0) | 1.000 |
| Endoscopic findings | |||
| Reflux esophagitis | 0.397 | ||
| Normal (%) | 9 (69.2) | 9 (81.8) | |
| LA grade A (%) | 2 (15.4) | 2 (18.2) | |
| LA grade B (%) | 2 (15.4) | 0 (0) | |
| Hiatal hernia (%) | 3 (23.1) | 3 (27.3) | 1.000 |
| Type of minor disorders of peristalsis | 0.078 | ||
| IEM (%) | 7 (41.2) | 10 (58.8) | |
| Fragmented peristalsis (%) | 6 (85.7) | 1 (14.3) | |
| HRM metrics | |||
| LES basal pressure (mmHg, mean±SD) | 15.2±6.4 | 12.9±6.7 | 0.397 |
| LES length (cm, mean±SD) | 2.9±0.5 | 2.9±0.3 | 0.951 |
| IRP (mmHg, mean±SD) | 4.9±4.4 | 6.3±3.9 | 0.438 |
| Effective swallows (%, mean±SD) | 47.9±27.5 | 43.9±31.7 | 0.742 |
| DCI (mmHg·s·cm, mean±SD) | 645.2±579.7 | 330.3±204.9 | 0.087 |
| EGJ morphology | 0.697 | ||
| EGJ type I, no hiatal hernia (%) | 7 (50.0) | 7 (50.0) | |
| EGJ type II, small hiatal hernia (%) | 6 (60.0) | 4 (40.0) | |
| pH metrics a | |||
| AET (%, mean±SD) | 1.6±2.5 | 2.1±2.3 | 0.703 |
| DeMeester score (mean±SD) | 6.2±8.6 | 8.7±8.6 | 0.615 |
| Impedance metrics a | |||
| All reflux proximal episodes (mean±SD) | 25.1±12.0 | 15.8±10.4 | 0.179 |
| All reflux distal episodes (mean±SD) | 44.8±15.1 | 35.4±21.9 | 0.378 |
| Median bolus exposure time (sec, mean±SD) | 12.9±5.7 | 10.0±4.6 | 0.365 |
| All reflux percent time (%, mean±SD) | 1.3±0.8 | 1.2±1.0 | 0.802 |
| Pathologic GER a | 6/8 (60.0) | 4/5 (40.0) | 1.000 |
| Therapeutic methods | 0.585 | ||
| PPI+Prokinetic agent (%) | 10 (52.6) | 9 (47.4) | |
| PPI alone (%) | 3 (60.0) | 2 (40.0) |
HRM, high-resolution manometry; 24-h MII/pH, 24-hour multichannel intraluminal impedance-pH; SD, standard deviation; BMI, body mass index; LA, Los Angeles; IEM, ineffective esophageal motility; LES, lower esophageal sphincter; IRP, integrated relaxation pressure; DCI, distal contractile integral; EGJ, esophagogastric junction; AET, acid exposure time; GER, gastroesophageal reflux; PPI, proton pump inhibitor.
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