Differences in esophageal corpus motility in patients with pathological and non-pathological gastroesophageal reflux. [Med Sci Monit] Journal article

Background: First- and second-order esophageal contractions are important factors responsible for esophageal clearance of refluxed gastric content. The aim of this study was to estimate the influence of acid reflux on second-order esophageal peristalsis. Material/
Methods: Simultaneous 24-h esophageal pH-metry and 24-h motility monitoring was performed in 213 patients with non-cardiac chest pain. Pathological gastroesophageal acid reflux (pGER) was defined as pH<4 for more than 4.5% of the total monitoring time.
Results: The group of pGER patients (n=65, 31%) had a lower percentage of complete and effective peristalsis, a higher percentage of incomplete peristalsis, and a lower mean contraction amplitude than the group of patients with normal esophageal acid exposure (nGER). Analysis of motility parameters in three periods, i.e. during acid reflux and 2 min before and 10 min after episodes (second-order peristalsis), showed that the pGER group had a lower percentage of effective peristalsis (20.6+/-13.3 vs. 29.6+/-16.2%, p=0.002) and a higher percentage of ineffective peristalsis both during and after acid reflux, a lower mean contraction amplitude (56.5+/-30.3 vs. 70.0+/-32.8 mmHg, p=0.025), and a lower contraction frequency during acid reflux (1.6+/-0.7 vs. 2.6+/-3.1/min, p=0.001) and 10 min after (1.9+/-1.9 vs. 20.6+/-30.2/min, p=0.002), which indicated a lack of esophageal peristalsis acceleration after acid reflux in the pGER group.
Conclusions: 1) pGER patients had ineffective esophageal peristalsis more frequently than nGER patients. 2) Impaired second-order peristalsis in pGER patients may be an important factor determining prolonged exposure of the esophageal mucosa to gastric content in addition to lower esophageal sphincter function.

Med Sci Monit