Role of Esophageal Body Motility Disorders in Gastroesophageal Reflux Disease

Background: Increased esophageal acid exposure contributes to the pathogenesis of gastroesophageal reflux disease(GERD),and the absence or dysmotility of esophageal body peristalsis may lead to esophageal clearance dysfunction.Aims:In order to reveal the role of esophageal body motility disorders in GERD,the aim of this study was to identify the prevalence of esophageal body motility disorders,including nonspecific esophageal motility disorder(NEMD)and ineffective esophageal motility(IEM)in patients with GERD,and to evaluate the relationship between NEMD and IEM,and gastroesophageal acid reflux and endoscopic esophagitis.Methods:Esophageal manometry and ambulatory24-hour esophageal pH monitoring were performed in116patients with GERD,and endoscopy was performed in75cases of these patients.Results:Ninety-eight pa-tients(84.5%)with GERD were found to have disordered motility in esophageal body.Among them,77were NEMD,and8were NEMD that were concordant with the diagnostic criteria for IEM.The total time percentage of pH4was significantly in-creased in GERD patients with NEMD or IEM than that in normal esophageal motility patients(8.0%±9.3%and15.7%±13.5%vs.3.0%±4.7%,P0.05);so did the upright and recumbent time percentages of pH4(upright time percentage:8.8%±11.1%and17.4%±21.0%vs.3.6%±4.1%,P0.01;recumbent time percentage:7.0%±10.4%and16.1%±12.2%vs.2.3%±6.7%,P0.05).The total esophageal acid clearance(EAC)time and upright EAC time were delayed markedly in GERD pa-tients with IEM when compared with those in normal esophageal motility patients(total EAC time:1.89min/reflux±1.82min/reflux vs.0.66min/reflux±0.58min/reflux,P0.05;upright EAC time:1.96min/reflux±1.96min/reflux vs.0.59min/reflux±0.48min/reflux,P0.05).Among the75GERD patients undergoing endoscopy,56.1%with NEMD and42.9%with IEM had endoscopic esophagitis,no significant difference was found as compared with the normal esophageal motility patients(69.2%).Conclusions:Esophageal body motility disorders can be detected in patients with GERD,and NEMD is more common.GERD patients with NEMD or IEM have more gastroesophageal acid reflux,and the acid clearance in patients with IEM de-layed more significantly,which indicate that both NEMD and IEM play important roles in GERD.The esophageal mucosal le-sions are not prerequisite for the occurrence of esophageal body motility disorders.