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Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease.

Publication ,  Journal Article
Mello, MD; Shriver, AR; Li, Y; Patel, A; Gyawali, CP
Published in: Neurogastroenterol Motil
February 2016

BACKGROUND: Ineffective esophageal motility (IEM) is associated with reflux disease, but its natural history is unclear. We evaluated patients undergoing repeat esophageal high resolution manometry (HRM) for symptomatic presentations after antireflux surgery (ARS) to understand the progression of IEM. METHODS: Patients with repeat HRM after ARS were included. Ineffective esophageal motility was diagnosed if ≥5 sequences had distal contractile integral (DCI) <450 mmHg cm s. Augmentation of DCI following multiple rapid swallows (MRS) was assessed. The esophagogastric junction (EGJ) was interrogated using the EGJ contractile integral (EGJ-CI). Esophageal motor function was compared between patients with and without IEM. KEY RESULTS: Sixty-eight patients (53.9 ± 1.8 years, 66.2% female) had pre- and post-ARS HRM studies 2.1 ± 0.19 years apart. Esophagogastric junction-CI augmented by a mean of 26.3% following ARS. Four IEM phenotypes were identified: 14.7% had persistent IEM, 8.8% resolved IEM after ARS, 19.1% developed new IEM, and 57.4% had no IEM at any point. Patients with IEM had a lower DCI pre- and post-ARS, lower pre-ARS EGJ CI, and lower pre-ARS-integrated relaxation pressure (p ≤ 0.02 for all comparisons); presenting symptoms and other EGJ metrics were similar (p ≥ 0.08 for all comparisons). The IEM phenotypes could be predicted by MRS DCI response patterns (p = 0.008 across groups); patients with persistent IEM had the least DCI augmentation (p = 0.007 compared to no IEM), while those who resolved IEM had DCI augmentation comparable to no IEM (p = 0.08). CONCLUSIONS & INFERENCES: Distinct phenotypes of IEM exist among symptomatic reflux patients following ARS. Provocative testing with MRS may help identify these phenotypes pre-ARS.

Duke Scholars

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

February 2016

Volume

28

Issue

2

Start / End Page

292 / 298

Location

England

Related Subject Headings

  • Phenotype
  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
  • Fundoplication
  • Female
  • Esophageal Motility Disorders
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mello, M. D., Shriver, A. R., Li, Y., Patel, A., & Gyawali, C. P. (2016). Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil, 28(2), 292–298. https://doi.org/10.1111/nmo.12728
Mello, M. D., A. R. Shriver, Y. Li, A. Patel, and C. P. Gyawali. “Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease.Neurogastroenterol Motil 28, no. 2 (February 2016): 292–98. https://doi.org/10.1111/nmo.12728.
Mello MD, Shriver AR, Li Y, Patel A, Gyawali CP. Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016 Feb;28(2):292–8.
Mello, M. D., et al. “Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease.Neurogastroenterol Motil, vol. 28, no. 2, Feb. 2016, pp. 292–98. Pubmed, doi:10.1111/nmo.12728.
Mello MD, Shriver AR, Li Y, Patel A, Gyawali CP. Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016 Feb;28(2):292–298.
Journal cover image

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

February 2016

Volume

28

Issue

2

Start / End Page

292 / 298

Location

England

Related Subject Headings

  • Phenotype
  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
  • Fundoplication
  • Female
  • Esophageal Motility Disorders