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Analysis of Peristalsis in Patients (pts) with Gastroesophageal Reflux Disease (GERD) like Symptoms (Sxs) Not Responding to Proton Pump Inhibitors (PPI)

24-Hour Manometry and pH Recording Study


Zhang, Yatian PhD; Levendoglu, Hulya MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S61
Abstracts: ESOPHAGUS

Division of Gastroenterology, The Brookdale University Hospital, Brooklyn, NY and Gastroenterology, SUNY, Downstate Medical Center, Brooklyn, NY.

Purpose: Many pts with GERD-like Sxs have neither significant acid reflux nor they respond to PPI therapy. We previously reported (Abstract S1155, GE: A-165:130, 2006) that these pts all have decreased distal primary peristalsis and increased simultaneous and isolated contractions.

Methods: We evaluated the patterns of peristaltic activity in 247 pts, and correlated the findings in motility with pH patterns (DeMeester Score). Data on the peristaltic activity recording all throughout the length of the esophagus was available in 219 pts. There were 157 females and 62 males age from 21 to 83 years with mean age 52 ± 12 years. 58 pts had high acid reflux scores (A), 98 pts high alkaline reflux scores (B), 18 pts high acid and high alkaline (combined) reflux scores (C) and 45 pts had no significant GER (D). Findings in peristalsis patterns are shown in Table 1.



Results: There were no significant differences in overall peristalsis and contractile patterns between A, B, C, D pts except A pts showed significantly lower overall peristaltic activity and higher peristaltic activity mixed with simultaneous contractions compared to B and C pts (p < 0.05). Effective peristalsis which sweeps the esophagus throughout its length constituted only 22.4–26.1% of the contractions.

Conclusions: Based on the above we conclude that pts with GERD-like Sxs unresponsive to PPI therapy are heterogenous group of pts with different reflux patterns: all have decreased primary peristalsis, most significantly in A pts. Overall less than one-fourth of the peristalsis is totally effective peristalsis in these pts.

© The American College of Gastroenterology 2006. All Rights Reserved.