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Ineffective or “Insignificant” Esophageal Motility Disorder in Gastroesophageal Reflux Disease (GERD)

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Kim, H. Jae, M.D.; Sharma, Virender K., M.D.; Harold, Kristi, M.D.; Schlinkert, Richard, M.D.; Crowell, Michael D., Ph.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S32
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Scottsdale, AZ and Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.

Purpose: Ineffective esophageal motility (IEM) is a common finding in patients with GERD. Laparoscopic nissen fundoplication (LNF) is the surgical treatment of choice for GERD. However, dysphagia may be reported following surgery. Patients with IEM may have dysphagia pre-surgically secondary to their underlying motility disorder, which may worsen after LNF. We aimed to evaluate the prevalence of IEM in GERD, and compare symptoms of dysphagia pre- and post LNF in IEM vs non-IEM patients.

Methods: LNFs performed between Jan and Dec 2004 were evaluated. Of 36 patient records, 35 completed esophageal manometry study (Solid-state esophageal manometry was performed following an overnight fast) and pre-op symptom assessment questionnaire. Seventeen patients completed pH-metry, and 34 completed EGD. All patients had a post-op follow up at 1 to 8 months.

Results: Thirty six fundoplications were performed; 33 laparoscopic and 3 open. Indications included GERD (30), achalasia (4), and paraesophageal (13) and large hiatal hernia (2) repairs (median age 61 y, range 21–85; 21 F; 34 caucasian, 2 hispanic). Thirty (83%) patients had either subjective or objective GERD (EGD/pH); 9 of 30 (30%) had IEM on manometry tracings (4 [13%] in subjective reflux only, 0 in objective reflux only, and 5 [17%] in both). IEM and non-IEM groups did not differ in age, gender, or race (64y ± 12; 80% F; 100% caucasian vs 59y ± 14; 59% F; 91% caucasian). Pre- and post-op dysphagia was noted in 30% and 40%, respectively, in IEM group and 50% (OR 0.43 [.09, 2.1]) and 43% (OR 0.96 [.21, 4.4]), respectively, in non-IEM group. Three of 9 (33%) IEMs had either symptomatic paraesophageal hernia or large hiatal hernia. Six of 9 (67%) IEMs had reduced lower esophageal sphincter pressures. Interestingly, 2 of 6 Toupet's were performed in GERD patients with IEM, which resulted in relief of pre-op dysphagia.

Conclusions: Ineffective esophageal motility may be a common finding in gastroesophageal reflux disease; however, the clinical significance remains unclear as the rate of pre- and post-op dysphagia did not differ between IEM vs non-IEM group. Well-designed prospective studies are needed to better elucidate the impact of esophageal dysmotility disorders on outcomes following esophageal surgery for GERD.

© The American College of Gastroenterology 2005. All Rights Reserved.